Heparin-induced inhibitory effects of a prothrombin complex concentrate on global tests of haemostasis
Heparin-induced inhibitory effects of a prothrombin complex concentrate on global tests of haemostasis
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DOI：
10.1097/01.mbc.0000256021.16453.de
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发表时间：
2007-01-01
影响因子：
1.1
通讯作者：
Yoshioka, Akira
中科院分区：
文献类型：
--
作者：
Takeyama, Masahiro;Sakurai, Yoshihiko;Yoshioka, Akira
凝血酶原复合物浓缩物（PCC）已被用作治疗A型血友病患者抑制剂的旁路药物，以及用于先天性和获得性维生素k依赖性凝血因子缺乏的替代疗法。然而，PCC的疗效是可变的，特别是在长期和高剂量使用期间，目前所有可获得的这种性质的产品都含有肝素。我们用缺乏凝血因子的血浆和洗过的血细胞混合合成的全血检测了PCC的止血性能。在旋转血栓弹性测量（ROTEM）中，推荐的治疗剂量Proplex ST纠正了异常模式。然而，在较高浓度下，ROTEM模式退化。此外，在2.5 U/ml Proplex ST存在时，凝血因子的特异性测定显得不可靠；当添加硫酸鱼精蛋白时，异常得到纠正。研究结果表明，肝素在PCC中的存在可能对全身止血有更大的作用。需要仔细注意PCC的抗凝作用和致血栓性。使用ROTEM分析等监测治疗可以提供大量信息。
Prothrombin complex concentrates (PCC) have been used as bypassing agents for the treatment of haemophilia A patients with inhibitor as well as for replacement therapy in congenital and acquired deficiencies of vitamin-K-dependent clotting factors. The efficacy of PCC is variable, however, especially during long-term and high-dose use, and all currently available products of this nature contain heparin. We have examined the haemostatic properties of PCC using reconstituted whole blood made by mixing coagulation-factor-deficient plasma and washed blood cells. In rotation thromboelastometry (ROTEM), the recommended therapeutic dose of Proplex ST corrected the abnormal patterns. At higher concentrations, however, the ROTEM patterns regressed. In addition, specific assays of coagulation factors appeared unreliable in the presence of 2.5 U/ml Proplex ST; the abnormalities were corrected when protamine sulfate was added. The findings suggest that the presence of heparin in PCC might have a greater effect on global haemostasis. Careful attention to the anticoagulant effect as well as thrombogenicity of PCC is required. Monitoring therapy using such as ROTEM analysis could be highly informative.