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Acute renal artery and vein thrombosis after renal transplant, associated with a short partial thromboplastin time and factor V Leiden mutation.

Renal graft thrombosis is a rare but devastating complication of renal transplantation. It accounts for one-third to one-half of early graft losses. We report a patient with acute renal artery and vein thrombosis associated with abnormally short activated partial thromboplastin time (aPTT) and factor V Leiden mutation. Vascular thrombosis developed on the ninth post-transplant day and led to a graft loss. Before transplantation, the patient had three episodes of thrombosis of arteriovenous access for hemodialysis. Our case illustrates the importance of investigating pretransplant patients for hypercoagulable states, particularly those with short aPTT.

Acute Disease↗

Comparative effects of the human protein C activator, Protac, on the activated partial thromboplastin clotting times of plasmas, with special reference to the dog.

The commercial snake venom extract, Protac, is a specific activator of the anticoagulant zymogen, protein C (PC) in human plasma. This specific action has led to its use in developing coagulation-based and amidolytic-based assays for the diagnosis of quantitative and/or qualitative PC deficiency states in human beings. The purpose of the present study was to compare the effects of Protac on the activated partial thromboplastin times (APTT) of human, bovine, equine, and canine plasmas in order to determine the potential value of this venom extract as an activator in functional PC assays in these domestic animal species. As expected, Protac significantly prolonged the APTT of normal human plasma, but had no effect on plasma known to be devoid of PC. Clotting times were prolonged by 34%-214% with concentrations of venom activator ranging from 0.1-1.0 U/mL. Under identical conditions, Protac prolonged the APTT of equine plasma by 11%-98% over control times. Even more dramatic was the inhibitory effect of Protac on the clotting of bovine plasma, extending the APTT more than 3-fold at a venom concentration of 0.1 U/mL. At higher venom concentrations, most bovine plasmas remained unclotted after 300 s (control time 34.1 s). Under similar conditions, the canine APTT was unaffected by Protac, even when the venom concentration was increased to 3 U/mL. In order to determine the reason for the lack in response of canine plasma, the concentration of the APTT reagent was altered (decreased), exposure time of the plasma to the Protac was increased from 2 min to 9 min, and the plasma was diluted to assess for the potential existence of plasma PC inhibitors. Protac caused an unexpected shortening of the APTT when the contact activator reagent was diluted. Increasing the exposure time had no effect. Although a slight prolongation of the canine APTT was detected when the plasma was diluted, the presence of strong plasma PC inhibition was considered an unlikely cause of the lack of significant anticoagulant action. The failure of Protac to exert a strong inhibitory effect on the canine APTT, as well as to generate amidolytic activity, suggests that this venom extract does not stimulate the production of activated PC activity in canine plasma. This may result from molecular differences in the canine PC molecule that prevent the formation of the stoichiometric complex of venom extract, APTT reagent, and canine protein, a complex thought to be essential for the PC-activating function of Protac. Protac may be suitable as an activator of PC in bovine and equine plasmas; however, it appears ineffective in generating anticoagulant activity in canine plasma.

Animals↗

[Effect of composition of reagents for activated partial thromboplastin time on their sensitivity during analysis of blood coagulation factors].

Brain cephaline-based reagents for evaluating activated partial thromboplastin time (APTT) and soybean phosphatides with ellagic acid complex activator with intermediate metal ions have been studied. The sensitivity of these reagents to internal clotting factors (VIII and IX) and heparin is determined by phospholipid nature and type of metal. The results help obtain highly active and sensitive APTT reagents.

Factor IX↗

A comparison of INRs determined with a whole blood prothrombin time device and two international reference preparations for thromboplastin.

Oral anticoagulant therapy is usually monitored with the prothrombin time (PT) on citrate plasma samples. In recent years instruments have been developed for measurement of the PT in non-citrated whole blood. In the present study, the manufacturer's calibration of one type of device (CoaguChek) in terms of the international normalized ratio (INR) was evaluated by one laboratory. Three subsequent lots of test strips for the CoaguChek were investigated using blood samples from 56 coumarin-treated patients. Citrated plasma samples from the same patients were analysed with two international reference preparations for thromboplastin (IRP), i.e., rTF/95 (recombinant human) and RBT/90 (rabbit brain). There were statistically significant INR differences between CoaguChek and the international reference preparations (p <0.001), but the mean relative deviation of the INR was not greater than 0.104. Clinically relevant criteria were used to assess the agreement between the CoaguChek and the IRP results. Standard agreement ranged from 82% to 95%. It is concluded that these test strips achieved a clinically acceptable level of accuracy. Further studies of patient management with these strips are justified.

Administration, Oral↗

[Follow-up of the treatment by direct thrombin inhibitors: activated partial thromboplastin time or ecarin clotting time].

The clinical use of the direct inhibitors of thrombin requires a reliable test to monitor the treatment and to predict the hemorragic risk. The activated partial thromboplastin time (APTT) is the most common test used to monitor treatment with unfractionated heparin. Thus APTT has been first chosen to follow patients treated with direct thrombin inhibitors, but studies have shown that it was probably not the most appropriate test. Indeed, APTT values were not well correlated with the dose administered and were dependent on the type of the thrombin inhibitor used and on the APTT reagent. The ecarin clotting time (ECT), which converts prothrombin into meizothrombin has been then tested and seemed to be a better test. In vitro studies have shown a good correlation between ECT and the different concentrations of thrombin inhibitors. Furthermore, the ECT in contrast to APTT is not sensitive to heparin or oral anticoagulant and interindividual variations are low with ECT. ECT which is a reliable test and is easy to perform seems to be a more appropriate test to monitor treatment with direct thrombin inhibitors but further studies are needed to validate its use in a clinical setting.

Animals↗

The partial thromboplastin time in the CAP survey program.

Analysis of the data for the 1969 to 1973 CAP Surveys of proficiency in partial thromboplastin time (PTT) determination indicates more than desirable variability in this measurement. Non-activated procedures show greater interlaboratory variability than activated methods; therefore, they may be preferable for routine use. It is likely that many laboratories have not determined their own upper limit of normal for their PTT system and thus have received unacceptable evaluations in the Surveys. It also was determined that many laboratories do not closely follow the manufacturer's directions, especially in regard to incubation times and calcium concentration of the recalcification solution.

Blood Coagulation Tests↗

[Sample taking through central venous catheter for the control of partial thromboplastin time in patients with heparin sodium perfusion].

The need to systematically monitor activated partial thromboplastin time (APTT) in patients undergoing continuous perfusion of heparin sodium (non-fractionated) in order to maintain therapeutic levels of anticoagulation leads to two questions: 1. can blood be withdrawn from the catheter through which the heparin solution is being perfused without altering APTT values? and 2. how much blood should be discarded so that APTT values remain unchanged? To obtain APTT values in these patients, two samples were extracted simultaneously: one through the central venous catheter through which the heparin was being perfused, after previously discarding 10 or 20 ml of blood according to the group to which the patient was assigned and the other through direct venous puncture or through the peripheral catheter inserted in the arm not being used for heparin perfusion. The values obtained by both methods were analyzed for statistical significance. Comparison of the results of APPT in the samples, having previously extracted 10 or 20 ml of blood, with those obtained through venous puncture or through peripheral venous catheter revealed statistically significant differences. These differences were lower when 20 ml were discarded than when 10 ml were discarded. In conclusion, APPT monitoring should be performed whether the sample is obtained through direct venous puncture or through a peripheral catheter inserted in the arm not being used for heparin perfusion.

Anticoagulants↗

[Effect of reagent batch on activated partial thromboplastin time in canine plasma and use of the ratio system for standardization].

In order to test the variability of the results of the activated partial thromboplastin time (APTT) in different reagent batches, 40 samples (20 from healthy dogs, 15 from patients with prolonged APTT as a result of different congenital or acquired haemostasis disorders, 5 from healthy dogs after in vitro addition of heparin) were used to compare 6 different lot Nos. of two commercial APTT-reagents (Pathromtin, PTT Reagent). Although the Friedman test showed a reagent batch dependency (p < 0.0001) for both reagents, only minor quantitative differences were observed with a variation coefficient of 2.7% (Pathromtin) and 2.4% (PTT Reagent), respectively. A second experiment was based on 105 samples measured with two batches of a third reagent (APTT-FS) with remarkable differences of results. Convergence of the results was achieved by converting into ratio values (quotient measurement value/control). However, statistical comparison still showed a significant difference. The study shows the good reproducibility of the APTT measured with different batches of the reagents Pathromtin and PTT Reagent in canine plasma, indicating that standardization is unnecessary. A standardization based on the ratio system can be used for reagents with a low batch consistency, requiring a high-quality control.

Animals↗

Pharmacokinetics and partial thromboplastin time after intravenous recombinant hirudin variant-2 in rhesus monkeys.

AIM: To study the pharmacokinetics (PK) and changes of kaolin partial thromboplastin time (KPTT) following single or multiple (7 d) dosing of a novel recombinant hirudin variant-2 (rHV-2) via the route of iv bolus injection (50 % of the total dose) plus infusion (the remained 50 % of the dose) in rhesus monkeys. METHODS: A crossover design was applied to research the PK and KPTT profiles of rHV-2 after single (with total dose at 1, 3, and 6 mg/kg, respectively) and multiple dosing (3 mg/kg). An enzyme-linked immunosorbent assay (ELISA) method was utilized to determine the level of rHV-2 in plasma. RESULTS: The concentration profiles of rHV-2 during or after administration were dependent both on the loading dose and the infusion rate. Mean Cmax after bolus in three single dose groups were 2.90, 9.78, and 15.68 mg/L, respectively. Infusions at rate of 8.35, 25, and 50 g/kg/h in 1 h resulted in steady-state levels of 0.73-0.86, 1.94-2.04, and 5.41-5.59 mg/L, respectively. The plasma rHV-2 levels during or after administration among doses were significantly different at most of the time points. Area under concentration-time curve (AUC) increased linearly with dose but systemic clearances were similar among different groups. KPTT was significantly prolonged (compared with baseline) at all dose levels, and trended to increase with dose. CONCLUSION: Both the loading dose and the infusion rate are very important for controlling the rHV-2 level, and the data may be helpful for optimizing dosage-regimen in clinical trials.

Animals↗

A reassessment of the relationship between international reference preparations for human and rabbit thromboplastins.

Two established international reference preparations (IRP) for thromboplastins, i.e. RBT/90 (rabbit, plain) and rTF/95 (recombinant human, plain) have been calibrated against each other in a 7-centre exercise performed in 2000. The purpose of the study was to compare the calibration results with those of the original calibration study performed in 1995. The international sensitivity index (ISI) for rTF/95 was calculated relative to the ISI for RBT/90. The mean ISI for rTF/95 was 0.961 (between-lab SD 0.028) which was 2% greater than the historical value determined in 1995. There is no indication that the two IRP have deteriorated, but further monitoring of the calibration relationship is recommended.

Animals↗

Comparison of five point-of-care prothrombin and activated partial thromboplastin time devices based on age of blood sample.

Delays in processing statium (STAT) blood samples have led to the production of an increasing number of point-of-care tests. Product inserts recommend measuring blood samples immediately after procurement, suggesting that delays may invalidate the test results. We studied the effect of the age of blood samples on point-of-care (POC) prothrombin time (PT) and an activated partial thromboplastin time (aPTT) result. Informed consent was obtained from 11 patients undergoing cardiopulmonary bypass (CPB). Blood samples (40 mL) were taken from each patient. Each blood sample was used to perform five PT tests and six aPTT tests on five POC devices (Gem PCL, Hemochron 801, Hemochron Jr. Signature, Hemochron Response, Rapidpoint Coag) at three different sample ages [< 60 s (fresh blood), 10 and 18 min after sample collection]. Blood samples were procured in a plastic syringe devoid of air bubbles, which was left undisturbed between tests but was gently agitated before initiating the 10- and 18-min tests. For tests requiring citrated whole blood, a fraction of each sample was anticoagulated (3.8% citrate) at each age. Statistical analysis was used for comparison of test results for fresh blood to aged samples (10 and 18 min). Test values were recorded as International Normalized Ratio (INR) and seconds for PT and aPTT, respectively. Two devices, the Hemochron 801 and Hemochron response showed statistically, although not clinically, significant variation in PT test results when the samples were aged to 10 and 18 minutes. As for aPTT results, Hemochron 801, Hemochron response, Hemochron Jr. signature, and Gem PCL showed statistically significant variation at 18 minutes. One device (Hemochron 801) reported results with 10-min aged blood that were statistically different from fresh blood. None of the aPTT tests results from any device produced results with aged blood that were clinically different from fresh blood. This study suggests that, in the tests evaluated, blood samples that have aged 10 or 18 min will produce clinically relevant aPTT and PT results, respectively.

Adult↗

[Unsuspected prolonged activated partial thromboplastin time in emergency surgery. Diagnostic and therapeutic guide].

Systematic complementary testing for asymptomatic patients before surgery yields an unexpectedly high percentage of anomalous results. Such results rarely affect perioperative management of the patient but may lead to unnecessary delays, which are potentially of great importance in emergency surgery. A 55-year-old woman with a clinical diagnosis of acute appendicitis was seen to have a prolonged activated partial thromboplastin time (APTT) of 1.94 before surgery. The patient's history did not suggest a coagulation disorder was likely, and when mixing normal and problem plasma failed to correct the APTT, we suspected an unspecified circulating anticoagulant was present. Surgery was delayed no further and no measures were taken. No excessive bleeding occurred during surgery or postoperative recovery. The main possible diagnoses for a women with unforeseen prolonged APTT are the presence of an unspecified circulating anticoagulant, factor XI or factor XII deficiency, or factor VIII deficiency associated with von Willebrand disease. Focusing on detecting a coagulation disorder while taking a patient's history and performing a simple laboratory test (mixing normal and problem plasma) can be useful for orienting management in emergency surgery.

Blood Coagulation Disorders↗

[The determination of activated partial thromboplastin time, coagulate time and thrombin time in patients with epistaxis of indeterminate cause].

OBJECTIVE: To explore the coagulation mechanism of indeterminate epistaxis. METHOD: 36 cases with epistaxis of indeterminate cause were studies by mean of detecting activated partial thromboplastin time (APTT), coagulate time (CT) and thrombin time. The results of first APTT, APTT after 8 min and CT were observed. RESULT: 1. The first APTT in epistaxis and normal group didn't show statistical difference (P > 0.05). But the APTT after 8 min in epistaxis were significantly different compared with the first APTT and that in normal group (P < 0.01). 2. The CT prolonged in 33.3% patients with epistaxis, which was higher significantly than that in the normal group (P < 0.01). (3) The epistaxis thrombin time (TT) was longer than that in normal group. CONCLUSION: The result suggest that during blood coagulation in indeterminate epistaxis, the activated factors in internal coagulating system may decompose more quickly than that in normal group. Antiagglutinating factors increase in blood.

Adolescent↗

[Study of storage stability of the commercial series of thromboplastin preparations].

The stability of commercial series of the thromboplastin preparation (obtained from rabbit brain) with calcium (TKS, Researach-and-Production Enterprise "Renam" MICH 1.1-1.2), of TKS "Tromborel" and of "Immunoplastin" (Technoclon) was comparatively studied. TKS "Renam" preserved its activity and sensitivity to factor VII in the liophilizated state for as long as 6 months. The preparations of "Renam", TKS, preserved the stable activity in the reconstructed liquid state, under the conditions of continuous storage, at 37 degrees C for 2 days, at 18-20 degrees C--for 2-3 days, and at 2-8 degrees C--for 5-7 days, which was accompanied by a stable high sensitivity to factor VII. The stability of the "Renam", TKS, was found to be similar to that of imported preparations.

Animals↗

An abnormal activated partial thromboplastin time clotting waveform is associated with high mortality and a procoagulant state.

We studied the associations of a biphasic waveform identified in 61 consecutive patients by activated partial thromboplastin times performed with an MDA 180 coagulation analyzer (bioMérieux Inc., Durham, NC, USA). The patients were encountered in a wide range of locations, including medical and surgical services, emergency and outpatient departments, and intensive care unit. The patients encountered also had a variety of clinical diagnoses. Of the patients, 42.6% were dead on follow-up evaluation at 3 months, and 67.2% had a clinical condition known to predispose to the development of disseminated intravascular coagulation (DIC). Sepsis was the most frequent associated condition and was present in 54% of the patients. Only 6 patients had overt DIC according to a standardized scoring system. However, D-dimer was elevated in 90% of patients, and antithrombin III and protein C levels decreased in 75.4% and 63.9%, respectively. The platelet count was decreased in 26%. Our results indicated that a biphasic waveform is associated with high mortality in general hospital patients and is frequently associated with sepsis. This waveform appears to be associated with a consumptive procoagulant state, which may represent early or nonovert DIC.

Adult↗

Thromboembolic risk factors in patients undergoing kidney transplant: implication of abnormally short activated partial thromboplastin time.

This study was designed to examine the relationship of short activated partial thromboplastin time (aPTT) and prothrombin time (PT) to the incidence of thromboembolic events, hereditary and acquired coagulation defects associated with an increased risk of thrombosis, or cardiovascular diseases in patients undergoing renal transplantation. The prevalence of these conditions in our patients (n = 436) was 55%. Forty-two percent of the patients had short aPTT or PT. Multivariate analysis revealed that patients with short aPTT have an odds ratio (OR) = 2.15, 95% Confidence Interval (CI) (1.27-3.64) (p = 0.0042), and for patients with short PT, an OR = 2.01, 95% CI (0.99-4.08) (p = 0.052). Our study also suggests that other risk factors, including non-white ethnicity (98% blacks), OR = 1.64, 95% CI (1.01-2.67) (p = 0.047), diabetes mellitus, OR = 2.62, 95% CI (1.11-6.18) (P = 0.028), and autosomal dominant polycystic kidney disease (ADPKD) (p < 0.0001). Short aPTT results, or probably short PT results, pre- or post-transplantation may be associated with increased risks for thromboembolism.

Adult↗

Activated partial thromboplastin time reagent sensitivity to the presence of the lupus anticoagulant.

The lupus anticoagulant (LA) is an acquired abnormality that is associated with a prolonged activated partial thromboplastin time (aPTT). It is one of the most frequent coagulation abnormalities seen in the routine clinical laboratory. The sensitivity of various commercial aPTT reagents varies in their ability to detect the LA. We undertook this evaluation by using a single coagulation instrument to determine the sensitivity of five different commercial aPTT reagents to the presence of the LA. We evaluated 23 patients with known LA using five different reagents, two of which were marketed as having enhanced LA sensitivity. All samples and testing were performed under the same conditions in a timely manner. Based on these data, essentially all of the commercial reagents that were tested could detect patients with known LA by at least minimally prolonging the aPTT. Some reagents were slightly better than others in their ability to detect the LA. For most hospitals, the detection of the LA is not the highest priority for the use of the aPTT assay. In most cases, heparin anticoagulation monitoring is the most common use of the aPTT assay. Since all five reagents are sensitive to the LA, then the best overall reagent will be the one with the best sensitivity to the most important need for the laboratory (usually heparin monitoring). Therefore, a reagent should be chosen based on the primary monitoring requirements of the aPTT assay, and greater than 90% of the patients with the LA will be detected.

Female↗

[Heat inactivation of tissue thromboplastin].

Molecular mechanism of thermal inactivation of thromboplastin from the human brain using 1H, 31P-NMR has been studied. It was concluded that heating causes denaturation of protein moiety, disturbs hexagonal (H11) form of packing, immobilizes the lipids and decreases the mobility of their molecular segments. The dynamic properties of lipids become more homogeneous.

Brain↗