The use of the activated clotting time for monitoring heparin therapy in critically ill patients
The use of the activated clotting time for monitoring heparin therapy in critically ill patients
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DOI：
10.1007/s00134-002-1609-7
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发表时间：
2003-02-01
影响因子：
38.9
通讯作者：
Colardyn, F
中科院分区：
文献类型：
--
作者：
Waele, JJ;Cauwenberghe, S;Colardyn, F
目的：探讨肝素静脉治疗患者活化凝血时间（ACT）与活化部分凝血活素时间（aPTT）的相关性，以及ACT预测抗凝水平的准确性。设计：从需要静脉注射未分离肝素的危重患者的方便样本中获得配对aPTT和ACT测量。aPTT在医院实验室测定，ACT测量用便携式设备进行。环境：根特大学医院的重症监护室，拥有54张床位的三级护理设施。患者和参与者：前瞻性研究28例患者；共获得105个配对样本。肝素治疗的适应症为脑缺血8例，各种心脏疾病10例，肺栓塞3例，持续血液滤过3例，外周动脉血栓形成4例。结果：aPTT与ACT有显著相关性。方差分析显示，不同抗凝水平、aPTT短于60 s（组1）、aPTT 60-90 s（组2）、aPTT长于90 s（组3）患者ACT差异显著：组1为142 +/- 16.7 s，组2、组3为155 +/- 29.6、192 +/- 39.1。结论：该ICU患者aPTT与ACT的相关性较差；ACT不能区分低抗凝水平和治疗抗凝水平。不推荐使用ACT监测ICU患者的低至中剂量肝素。
Objective: To determine the correlation between activated clotting time (ACT) and activated partial thromboplastin time (aPTT) in patients receiving intravenous unfractionated heparin therapy, and the accuracy of the ACT in predicting the level of anticoagulation. Design: Paired aPTT and ACT measurements were obtained from a convenience sample of critically ill patients requiring intravenous unfractionated heparin. The aPTT was determined in the hospital laboratory and ACT measurements were performed with a portable device. Setting: The intensive care unit of Ghent University Hospital, a tertiary care facility with 54 beds. Patients and participants: Twenty-eight patients were studied prospectively; a total of 105 paired samples were obtained. The indication for heparin therapy was cerebral ischemia in 8, various cardiac conditions in 10, pulmonary embolism in 3, continuous hemofiltration in 3, and peripheral arterial thrombosis in 4. Results: There was a significant correlation between aPTT and ACT. Analysis of variance showed a significant difference in ACT between different levels of anticoagulation, aPTT shorter than 60 s (group 1), aPTT 60-90 s (group 2), and aPTT longer than 90 s (group 3): 142 +/- 16.7 s in group I vs. 155 +/- 29.6 and 192 +/- 39.1 in groups 2 and 3. Conclusions: The correlation between the aPTT and the ACT in this ICU setting is poor; ACT cannot differentiate between low and therapeutic levels of anticoagulation. The use of the ACT for monitoring low to moderate doses of heparin in ICU patients cannot be recommended.