Title
Disagreement between bedside and laboratory activated partial thromboplastin time and international normalized ratio for various novel anticoagulants
Author
Kemme, M.J.B.
Faaij, R.A.
Schoemaker, R.C.
Kluft, C.
Meijer, P.
Cohen, A.F.
Burggraaf, J.
Gaubius Instituut TNO
Publication year
2001
Abstract
During studies on warfarin, heparin and various anticoagulants with novel mechanisms of action, the activated partial thromboplastin time (aPTT) and the (apparent) international normalized ratio (INR) from a bedside monitor (Coagucheck Plus®) were compared with laboratory assay results. Data were compared using the Bland and Altman method of comparison where systematic differences result in significant slopes of the regression line. During heparin treatment, the bedside monitor largely underestimated the aPTT (slope=-0.80). During treatment with the direct thrombin inhibitor napsagatran (slope=0.99), the pentasaccharides Org31540/SR90107A (slope=0.77) and SanOrg34006 (slope=0.35), and warfarin (slope=0.60), the bedside monitor underestimated the aPTT at lower aPTT levels, while at higher aPTT levels it overestimated the laboratory values. The bedside monitor slightly overestimated the INR during treatment with warfarin (slope=0.33). Apparent INR was largely overestimated during treatment with Org31540/SR90107A (slope=1.38), SanOrg34006 (slope=0.97), Napsagatran (slope=1.23), and recombinant tissue factor pathway inhibitor (slope=1.48, P < 0.001 for all regression lines). These results indicate that a substantial disagreement in aPTT or (apparent) INR exists between the bedside monitor and laboratory assay during treatment with the studied 'classic' and novel anticoagulants. The amount of disagreement depended on the anticoagulant given. © 2001 Lippincott Williams & Wilkins. Chemicals/CAS: Anticoagulants; Antithrombins; Fibrinolytic Agents; Heparin, 9005-49-6; Naphthalenes; Oligosaccharides; Org 31540, 104993-28-4; Piperidines; Ro 46-6240; SANORG 34006; Warfarin, 81-81-2
Subject
Activated partial thromboplastin time
Bedside monitor
International normalized ratio
Prothrombin time
Anticoagulant agent
Fondaparinux
Napsagatran
Recombinant tissue factor pathway inhibitor
Adult
Blood clotting parameters
Blood sampling
Clinical article
Intermethod comparison
Laboratory test
Outpatient care
Partial thromboplastin time
Prothrombin time
Thromboembolism
Anticoagulants
Antithrombins
Drug Monitoring
False Negative Reactions
False Positive Reactions
Fibrinolytic Agents
Heparin
Humans
Laboratories
Naphthalenes
Oligosaccharides
Partial Thromboplastin Time
Piperidines
Point-of-Care Systems
Reproducibility of Results
Warfarin
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DOI
https://doi.org/10.1097/00001721-200110000-00012
TNO identifier
236278
ISSN
0957-5235
Source
Blood Coagulation and Fibrinolysis, 12 (7), 583-591
Document type
article