Role of thromboelastography and rapid thromboelastography to assess the pharmacodynamic effects of vitamin K antagonists
Role of thromboelastography and rapid thromboelastography to assess the pharmacodynamic effects of vitamin K antagonists
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DOI：
10.1007/s11239-014-1130-1
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发表时间：
2015-07-01
影响因子：
4
通讯作者：
Angiolillo, Dominick J.
中科院分区：
文献类型：
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作者：
Franchi, Francesco;Hammad, Jafri Syed;Angiolillo, Dominick J.
血栓弹力图（TEG）通过评价体外凝块形成的粘弹性来评估整体功能性凝血状态，从而测量抗血栓药物的作用。最近，快速TEG（r-TEG），它使用组织因子除了标准高岭土，以加速激活凝血级联，已被提出，以获得更直接的结果。尚未探索维生素K拮抗剂（VKA）治疗患者的TEG或r-TEG结果与国际标准化比值（INR）之间的相关性，这是本研究的目的。接受VKA长期治疗的患者（n = 100）被纳入一项观察性前瞻性药效学研究。评价了TEG参数，特别是血栓生成标志物[反应时间（R）、最大血栓生成率（MRTG）和至最大血栓生成率时间（TMRTG）]与INR值之间的相关性以及这些参数与治疗INR范围之间的一致性。此外，在一个受试者亚组（n = 17）中，还评估了r-TEG参数与TEG参数和INR值的相关性。未发现INR与血栓生成的TEG参数之间存在相关性，特别是INR与R（r = 0.189，p = 0.06）、MRTG（r =-0.027，p = 0.79）和TMRTG（r = 0.188，p = 0.06）之间。此外，未发现这些参数与推荐的INR范围之间的一致性。INR与活化凝血时间（r（S）= 0.546，p < 0.001）、r-R（r（S）= 0.572，p = 0.017）和r-TMRTG（r（S）= 0.510，p = 0.037）之间存在显著的斯皮尔曼相关性，但与r-MRTG无关（r（S）= 0.131，p = 0.617）。TEG和r-TEG分别在24 +/-A6和12 +/-A4 min获得结果（p < 0.001）。在接受长期VKA治疗的患者中，与标准INR测量值相比，TEG不是评价VKA抗凝作用的有用工具。然而，血栓生成的r-TEG参数与INR水平相关，表明该测定法可能用于更快速地测量抗凝治疗效果。
Thromboelastography (TEG) measures the effects of antithrombotic agents by assessing global functional clotting status by evaluating the viscoelastic properties of in vitro clot formation. Recently, rapid TEG (r-TEG), which uses tissue factor in addition to standard kaolin to accelerate activation of the clotting cascade, has been proposed to obtain more immediate results. The correlation between results of TEG or r-TEG with international normalized ratio (INR) in patients on vitamin K antagonist (VKA) therapy has not been explored and represents the aim of this study. Patients on chronic therapy with VKAs (n = 100) were included in an observational prospective pharmacodynamic study. The correlation between TEG parameters, in particular markers of thrombus generation [Reaction time (R), maximum rate of thrombus generation (MRTG), and time to maximum rate of thrombus generation (TMRTG)], and INR values as well as the concordance between these parameters and therapeutic INR ranges were evaluated. In addition, in a subgroup of subjects (n = 17), the correlation of r-TEG parameters with TEG parameters and INR values was also assessed. No correlation was found between INR and TEG parameters of thrombus generation, in particular between INR and R (r = 0.189, p = 0.06), MRTG (r = -0.027, p = 0.79), and TMRTG (r = 0.188, p = 0.06). Further, no concordance was found between these parameters and recommended INR ranges. Significant Spearman correlations were found between INR and activated clotting time (r(S) = 0.546, p < 0.001), r-R (r(S) = 0.572, p = 0.017), and r-TMRTG (r(S) = 0.510, p = 0.037), but not r-MRTG (r(S) = 0.131, p = 0.617). Results were obtained in 24 +/- A 6 versus 12 +/- A 4 min with TEG and r-TEG, respectively (p < 0.001). In patients on chronic VKA therapy, TEG is not a useful tool to evaluate VKA anticoagulant effect, compared with standard INR measurements. However, r-TEG parameters of thrombus generation correlate with INR levels, suggesting a possible role of this assay for measuring more expeditiously anticoagulant treatment effects.