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Adcock DM, Moore GW, Montalvão SDL, Kershaw G, Gosselin RC. Activated Partial Thromboplastin Time and Prothrombin Time Mixing Studies: Current State of the Art. Semin Thromb Hemost 2023; 49:571-579. [PMID: 36055261 DOI: 10.1055/s-0042-1756196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Mixing studies have long been in the clinical laboratory armamentarium for investigating unexpected, prolonged activated partial thromboplastin time (aPTT) or prothrombin time (PT). The purpose of the mixing study is to identify whether the aPTT/PT prolongation is secondary to a factor deficiency versus an inhibitor, which would present as a "corrected" and "noncorrected" mixing study, respectively. The differentiation between a factor deficiency and inhibitor may likely further direct clinical decisions, including additional diagnostic testing or factor replacement therapy. While aPTT/PT mixing studies are simple tests to perform, there is a lack of standardization for both the testing protocol and the interpretation of what is considered to be a corrected or noncorrected mixing study result. This review will describe the common indications for the mixing test, preanalytic variables that may affect mixing study performance, and describe several methods for interpreting the results of aPTT and PT mixing tests.
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Affiliation(s)
| | - Gary W Moore
- Specialist Haemostasis Unit, Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Natural Sciences, Middlesex University London, London, United Kingdom
| | - Silmara de Lima Montalvão
- Laboratory Hemostasis, Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Geoffrey Kershaw
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Robert C Gosselin
- Davis Health System, Hemostasis and Thrombosis Center, University of California, Sacramento, California
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Magnetic Properties and Biocompatibility of Different Thickness (Pd/Fe) n Coatings Deposited on Pure Ti Surface via Multi Arc Ion Plating. MATERIALS 2022; 15:ma15051831. [PMID: 35269062 PMCID: PMC8911732 DOI: 10.3390/ma15051831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 01/27/2023]
Abstract
The different thickness (Fe/Pd)n coatings were prepared by vacuum ion plating technology on a pure Ti substrate. The (Fe/Pd)n coatings were magnetized using an MC-4000 high-pressure magnetizing machine. Then, the effect of the (Fe/Pd)n coating thickness on the magnetic properties was studied. The surface and section morphology, composition, phase structure, magnetic properties, and biocompatibility of the (Fe/Pd)n coatings were studied by scanning electron microscopy, X-ray diffraction, energy-dispersive X-ray spectroscopy, and CCTC-1 digital flux field measurement. The results showed that the (Fe/Pd)n coatings were granular, smooth, and compact, without cracks. In addition the (Fe/Pd)n coatings formed an L10 phase with a magnetic face-centered tetragonal-ordered structure after heat treatment. With the increase in the thickness of (FePd)n coatings, the content of L10 FePd phase increased and the remanence increased. The remanence values of the Fe/Pd, (Fe/Pd)5, (Fe/Pd)10, and (Fe/Pd)15 magnetic coatings were 0.83 Gs, 5.52 Gs, 7.14 Gs, and 7.94 Gs, respectively. Additionally, the (Fe/Pd)n magnetic coatings showed good blood compatibility and histocompatibility.
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Chen T, Chen D, Chen L, Chen Z, Wang B, Zhou D. The effects of fructose diphosphate on routine coagulation tests in vitro. Sci Rep 2022; 12:304. [PMID: 34997135 PMCID: PMC8741944 DOI: 10.1038/s41598-021-04263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
To evaluate the effects of fructose diphosphate (FDP) on routine coagulation tests in vitro, we added FDP into the mixed normal plasma to obtain the final concentration of 0, 1, 2, 3, 4, 5, 6, 10, 15, 20, 25, 30 and 35 mg/mL of drug. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (FBG) and thrombin time (TT) of samples were analyzed with blood coagulation analyzers from four different manufacturers(Sysmex, Stago, SEKISUI and Werfen) and their corresponding reagents, respectively. Before the experiment, we also observed whether there were significant differences in coagulation test results of different lots of reagents produced by each manufacturer. At the same time as the four routine clotting tests, the Sysmex blood coagulation analyzer and its proprietary analysis software were used to detect the change of maximum platelet aggregation rate in platelet-rich plasma after adding FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL). The results of PT, aPTT and TT showed a FDP (0-35 mg/mL) concentration-dependent increase and a FBG concentration-dependent decrease. The degree of change (increase or decrease) varied depending on the assay system, with PT and aPTT being more affected by the Sysmex blood coagulation testing instrument reagent system and less affected by CEKISUI, TT less affected by CEKISUI and more affected by Stago, and FBG less affected by Stago and more affected by Sysmex. The results of PT, aPTT and TT were statistically positively correlated with their FDP concentrations, while FBG was negatively correlated. The correlation coefficients between FDP and the coagulation testing systems of Sysmex, Stago, Werfen and SEKISUI were 0.975, 0.988, 0.967, 0.986 for PT, and 0.993, 0.989, 0.990 and 0.962 for aPTT, 0.994, 0.960, 0.977 and 0.982 for TT, - 0.990, - 0.983, - 0.989 and - 0.954 for FBG, respectively. Different concentrations of FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL) had different effects on the maximum aggregation rate of platelet induced by the agonists of adenosine diphosphate (ADP, 5 µmol/L), arachidonic acid (Ara, 1 mmol/L), collagen (Col, 2.5 µg/mL) and epinephrine (Epi,10 µmol/L), but the overall downward trend was consistent, that is, with the increase of FDP concentration, the platelet aggregation rate decreased significantly. Our experimental study demonstrated a possible effect of FDP on the assays of coagulation and Platelet aggregation, which may arise because the drug interferes with the coagulation and platelet aggregation detection system, or it may affect our in vivo coagulation system and Platelet aggregation function, the real mechanism of which remains to be further verified and studied.
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Affiliation(s)
- Tongqing Chen
- Blood Transfusion Department, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China
| | - Duan Chen
- Clinical Medicine (5+3 Integration) 2020 Year 4 Class, School of Basic Medical Sciences, Wuhan University Medical School, Wuhan, Hubei, China
| | - Lu Chen
- Blood Transfusion Department, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China
| | - Zhengxu Chen
- Clinical Laboratory Department, The Second People's Hospital of Hefei, Anhui, China
| | - Baolong Wang
- Clinical Laboratory Department, The First Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Daoping Zhou
- Department of Oncology, Anhui No. 2 Provincial People's Hospital, 6nd Floor,Building B, Hefei, Anhui, China.
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Lippi G, Adcock D, Favaloro EJ. Understanding the "philosophy" of laboratory hemostasis. ACTA ACUST UNITED AC 2020; 6:223-226. [PMID: 30827079 DOI: 10.1515/dx-2018-0099] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
Unlike many other areas of laboratory medicine, laboratory hemostasis has some peculiarities, which makes it one of the most complex diagnostic domains in clinical medicine. The inherent complexity of the hemostasis process, the components of which have not yet been thoroughly unravelled, is mirrored by a large number of hemostasis disturbances, which can involve single or multiple components. Although laboratory diagnostics represents an unavoidable part of the diagnostic reasoning in patients with bleeding or thrombotic disorders, the basic concept beneath the assumption that in many human pathologies, one single test may be sufficient for the diagnosis, does not hold true in hemostasis. There are in fact many aspects that would lead us to conclude that laboratory hemostasis can be considered a very challenging arena for many clinicians and perhaps also for some laboratory professionals. The most challenging aspects typically include the following concepts; that hemostasis is an intricate and multifaceted process, that more than one test is typically needed to achieve a final diagnosis, that results of screening tests depend on many biological factors and do not allow making a final diagnosis, that harmonization of techniques is still an unmet target, and that the calculations used vary widely among laboratories. This article is hence aimed at discussing many of these aspects, with the hope of presenting a useful contribution to better understand the "philosophy" of laboratory hemostasis.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, P.le LA Scuro 10, Verona 37134, Italy
| | - Dorothy Adcock
- Laboratory Corporation of AmericaHoldings, Colorado Coagulation, Englewood, CO, USA
| | - Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
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Effects of Oritavancin on Coagulation Tests in the Clinical Laboratory. Antimicrob Agents Chemother 2017; 61:AAC.01968-16. [PMID: 27956417 DOI: 10.1128/aac.01968-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/25/2016] [Indexed: 11/20/2022] Open
Abstract
Previous studies have shown that some lipoglycopeptide and lipopeptide antimicrobial agents may cause falsely elevated values for some phospholipid-dependent coagulation tests. The effect of oritavancin, a lipoglycopeptide antibiotic, on coagulation test results was explored using pooled human plasma samples spiked with drug and in a clinical study after an infusion of a single 1,200-mg intravenous dose of oritavancin in normal healthy volunteers. Pooled plasma with oritavancin added ex vivo showed concentration-dependent prolongation of prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), and dilute Russell viper venom time (DRVVT) test results. In contrast, oritavancin had no effect on the activated protein C resistance assay, chromogenic anti-factor Xa assay (anti-FXa), thrombin time, and an immunoassay for the laboratory diagnosis of heparin-induced thrombocytopenia. In participants that received a single dose of oritavancin, elevations in PT/INR result, aPTT, DRVVT, activated clotting time, and silica clotting time occurred, with the maximum times to resolution of test interference determined to be 12, 120, 72, 24, and 18 h, respectively. The anti-FXa assay was unaffected, whereas transient elevations in D dimer levels were observed in 30% of participants, with a maximum time to resolution of 72 h. Although oritavancin has no impact on the coagulation system in vivo, a single dose of oritavancin can produce falsely elevated values of some coagulation tests used to monitor hemostasis. The interference of oritavancin on affected tests is transient, and the test results revert to normal ranges within specified times after dosing.
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Yamada T, Kato R, Oda K, Tanaka H, Suzuki K, Ijiri Y, Ikemoto T, Nishihara M, Hayashi T, Tanaka K, Tamai H, Ukimura A, Katsumata T. False Prolongation of Prothrombin Time in the Presence of a High Blood Concentration of Daptomycin. Basic Clin Pharmacol Toxicol 2016; 119:353-9. [PMID: 27060578 DOI: 10.1111/bcpt.12597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/01/2016] [Indexed: 12/13/2022]
Abstract
Prothrombin time (PT) can reportedly be falsely prolonged by the antimicrobial drug daptomycin (DAP), and concomitant use of phosphatidylglycerol (PG). Although high doses of DAP (>6 mg/kg/day) are recommended for severe infection and result in a high blood concentration, the extent to which high blood concentrations of DAP interfere with PT, in the presence or absence of PG, has yet to be determined when using the HemosIL RecombiPlasTin 2G (Werfen Japan, Tokyo, Japan). We examined the effects of high doses of DAP on PT using this reagent. DAP (0-500 mg/L) was added to normal plasma and plasma with an already prolonged PT in the presence or absence of liposomal amphotericin B (L-AMB, 5-50 mg/L) or COATSOME EL-01 empty cationic liposomes (CS, 25-250 mg/L). Furthermore, we undertook a Monte Carlo simulation to calculate the probability of achieving DAP concentrations >100, >200 and >500 mg/L 0-48 hr after administering 6-12 mg/kg of DAP. Apparent PT increased with increasing DAP concentration, but neither L-AMB nor CS appeared to further elevate PT when co-administered with DAP. The probability of achieving DAP concentrations >100 and >200 mg/L increased with DAP dose. Higher doses of DAP than the approved dose caused false prolongation of PT. PT should be monitored carefully in patients taking high doses of DAP; ideally, PT should be measured at the trough blood concentration of DAP. Concomitant use of L-AMB and CS did not generally further elevate PT when co-administered with DAP.
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Affiliation(s)
- Tomoyuki Yamada
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan. .,Infection Control Center, Osaka Medical College Hospital, Takatsuki, Osaka, Japan.
| | - Ryuji Kato
- Laboratory of Cardiovascular Pharmacology and Toxicology, Osaka University of Pharmaceutical Sciences, Osaka, Japan
| | - Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
| | - Hidema Tanaka
- Department of Clinical Laboratory, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Kaoru Suzuki
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Yoshio Ijiri
- Laboratory of Cardiovascular Pharmacology and Toxicology, Osaka University of Pharmaceutical Sciences, Osaka, Japan
| | - Toshiyuki Ikemoto
- Department of Clinical Laboratory, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Masami Nishihara
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Tetsuya Hayashi
- Laboratory of Cardiovascular Pharmacology and Toxicology, Osaka University of Pharmaceutical Sciences, Osaka, Japan.,Department of Internal Medicine III, Osaka Medical College, Osaka, Japan
| | | | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Akira Ukimura
- Infection Control Center, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Takahiro Katsumata
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
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Van Bambeke F. Lipoglycopeptide Antibacterial Agents in Gram-Positive Infections: A Comparative Review. Drugs 2015; 75:2073-95. [DOI: 10.1007/s40265-015-0505-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Corey GR, Rubinstein E, Stryjewski ME, Bassetti M, Barriere SL. Potential role for telavancin in bacteremic infections due to gram-positive pathogens: focus on Staphylococcus aureus. Clin Infect Dis 2015; 60:787-96. [PMID: 25472944 PMCID: PMC4329924 DOI: 10.1093/cid/ciu971] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is one of the most common serious bacterial infections and the most frequent invasive infection due to methicillin-resistant S. aureus (MRSA). Treatment is challenging, particularly for MRSA, because of limited treatment options. Telavancin is a bactericidal lipoglycopeptide antibiotic that is active against a range of clinically relevant gram-positive pathogens including MRSA. In experimental animal models of sepsis telavancin was shown to be more effective than vancomycin. In clinically evaluable patients enrolled in a pilot study of uncomplicated SAB, cure rates were 88% for telavancin and 89% for standard therapy. Among patients with infection due to only gram-positive pathogens enrolled in the 2 phase 3 studies of telavancin for treatment of hospital-acquired pneumonia, cure rates for those with bacteremic S. aureus pneumonia were 41% (9/22, telavancin) and 40% (10/25, vancomycin) with identical mortality rates. These data support further evaluation of telavancin in larger, prospective studies of SAB.
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Affiliation(s)
- G Ralph Corey
- Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina
| | - Ethan Rubinstein
- Section of Infectious Diseases, Department of Internal Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Martin E Stryjewski
- Department of Medicine, Section of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas 'Norberto Quirno' (CEMIC), Ciudad Autónoma de Buenos Aires, Argentina
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia, Udine, Italy
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Impact of telavancin on prothrombin time and activated partial thromboplastin time as determined using point-of-care coagulometers. J Thromb Thrombolysis 2013; 38:235-40. [DOI: 10.1007/s11239-013-1004-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Case report: artificial elevation of prothrombin time by telavancin. Clin Orthop Relat Res 2013; 471:332-5. [PMID: 23129464 PMCID: PMC3528902 DOI: 10.1007/s11999-012-2612-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 09/10/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus infections are a well-documented risk of surgery and are becoming increasingly difficult to treat owing to continued acquired resistance. A new antibiotic for treatment of Staphylococcus aureus is telavancin. CASE DESCRIPTION A patient at our institution was prescribed telavancin for multiple spinal abscesses before spinal surgery. Routine preoperative testing revealed an international normalized ratio (INR) of 2.05 with no clear cause. Careful review of the patient's medication history and prescriber information revealed that telavancin may interfere with prothrombin time (PT/INR) testing. In vitro testing by our laboratory confirmed an association between telavancin dose and an increase in PT/INR. An alternative reagent for PT/INR testing unaffected by telavancin dose revealed a PT/INR of 0.97. LITERATURE REVIEW Telavancin interacts with artificial phospholipid surfaces used to monitor coagulation while having no actual effect on coagulation. PURPOSES AND CLINICAL RELEVANCE All physicians, especially orthopaedic surgeons, should be aware of the effects of telavancin and ensure proper measures are taken to acquire the true INR by switching the reagent used to test PT/INR or ensuring the PT/INR is drawn before telavancin dosing.
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