TEG® and RapidTEG® are unreliable for detecting warfarin- coagulopathy: a prospective cohort study
TEG® and RapidTEG® are unreliable for detecting warfarin- coagulopathy: a prospective cohort study
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DOI：
10.1186/1477-9560-12-4
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发表时间：
2014-01-01
影响因子：
3.1
通讯作者：
Hoffman, David A.
中科院分区：
文献类型：
--
作者：
Dunham, C. Michael;Rabel, Charlene;Hoffman, David A.
背景：血栓弹力图 (TEG) 利用高岭土（一种内在途径激活剂）来评估凝血功能。最近发表的研究表明，尽管国际标准化比值 (INR) 有所增加，但接受华法林治疗的患者 TEG 结果通常正常。由于 RapidTEG T 包含组织因子（一种外源性途径激活剂）以及高岭土，因此我们假设 RapidTEG 在检测华法林效应方面会更敏感。 方法：这项前瞻性研究包括 22 名连续接受选择性心脏复律并接受华法林治疗的患者。在心脏复律之前，收集血液以评估 INR、凝血酶原时间、TEG 和 RapidTEG。结果：INR 结果：2.8 +/- 0.5（1.6 至 4.2）。凝血酶原时间结果：19.1 +/- 2.2（13.9. 至 24.3）。 TEG 结果（参考范围）：R-时间：8.3 +/- 2.7 (2-8)； K-时间：2.1 +/- 1.4 (1-3)；角度：62.5 +/- 10.3 (55-78)； MA：63.2+/-10.3（51-69）； G：9.4+/-3.5（4.6-10.9）； R-时间在正常范围内：10 (45.5%)，INR 2.9 +/- 0.3； INR 和 5 个 TEG 变量的相关系数均不显着 (P > 0.05)。 RapidTEG 结果（参考范围）：ACT：132 +/- 58 (86-118)； K-时间：1.2 +/- 0.5 (1-2)；角度：75.4 +/- 5.2 (64-80)； MA：63.4 +/- 5.1（52-71）； G：8.9+/-2.0（5.0-11.6）； ACT 在正常范围内：9 (40.9%)，INR 2.7 +/- 0.5； INR 和 5 个 RapidTEG 变量中每一个变量的相关系数均不显着 (P > 0.05)。结论：尽管 INR 增加，但使用高岭土活化的 TEG 和使用高岭土和组织因子活化的 RapidTEG 在相当大比例的华法林患者中均正常。这两种测试检测华法林凝血病的假阴性率都是不可接受的。 INR 与所有 TEG 和 RapidTEG 成分之间缺乏相关性进一步表明这些方法对华法林效应不敏感。研究结果表明，内源性途径激活可能会减轻外源性途径凝血病的检测。
Background: Thromboelastography r (TEG) utilizes kaolin, an intrinsic pathway activator, to assess clotting function. Recent published studies suggest that TEG results are commonly normal in patients receiving warfarin, despite an increased International Normalized Ratio (INR). Because RapidTEG T includes tissue factor, an extrinsic pathway activator, as well as kaolin, we hypothesized that RapidTEG would be more sensitive in detecting a warfarin-effect.Methods: Included in this prospective study were 22 consecutive patients undergoing elective cardioversion and receiving warfarin. Prior to cardioversion, blood was collected to assess INR, Prothrombin Time, TEG, and RapidTEG.Results: INR Results: 2.8 +/- 0.5 (1.6 to 4.2). Prothrombin Time Results: 19.1 +/- 2.2 (13.9. to 24.3). TEG Results (Reference Range): R-Time: 8.3 +/- 2.7 (2-8); K-Time: 2.1 +/- 1.4 (1-3); Angle: 62.5 +/- 10.3 (55-78); MA: 63.2 +/- 10.3 (51-69); G: 9.4 +/- 3.5 (4.6-10.9); R-Time within normal range: 10 (45.5%) with INR 2.9 +/- 0.3; Correlation coefficients for INR and each of the 5 TEG variables were insignificant (P > 0.05). RapidTEG Results (Reference Range): ACT: 132 +/- 58 (86-118); K-Time: 1.2 +/- 0.5 (1-2); Angle: 75.4 +/- 5.2 (64-80); MA: 63.4 +/- 5.1 (52-71); G: 8.9 +/- 2.0 (5.0-11.6); ACT within normal range: 9 (40.9%) with INR 2.7 +/- 0.5; Correlation coefficients for INR and each of the 5 RapidTEG variables were insignificant (P > 0.05).Conclusions: TEG, using kaolin activation, and RapidTEG, with kaolin and tissue factor activation, were normal in a substantial percent of warfarin patients, despite an increased INR. The false-negative rate for detecting warfarin coagulopathy with either test is unacceptable. The lack of correlation between INR and all TEG and RapidTEG components further indicates that these methodologies are insensitive to warfarin effects. Findings suggest that intrinsic pathway activation may mitigate detection of an extrinsic pathway coagulopathy.