![]() ![]() This is routinely done with Owren PT-INR (Prothrombin Time-International Normalized Ratio), which represents the formation of fibrin from fibrinogen, catalysed by thrombin. Patients on warfarin need to be monitored regularly to guide the anticoagulative treatment. This suppresses the binding of calcium to these factors, which is necessary for their activation. Warfarin is a commonly prescribed anticoagulant which inhibits the enzyme vitamin K reductase and thus prevents the γ-carboxylation of the vitamin K dependent procoagulant factors FII, FV, FIX and FX as well as the anticoagulant proteins C, S and Z. Further studies are needed to verify if a ROTEM CT in the lower normal range of <57-65 s, as found in our in vitro APCC-spiked warfarin blood, is safe for invasive procedures. ROTEM CT should be tested with non-activated PCC for in vivo reversal of warfarin in patients along with verification of a normalised PT. With the diluted TF no CT shortening was found with APCC.Ĭonclusion: A clear dose response of APCC added in vitro to correct the effects of warfarin on ROTEM EXTEM CT was verified. ![]() There was no effect on maximal clot strength with APCC. ROTEM signals of clot propagation to clot formation time (CFT) and α angle had the reverse pattern. This was most evident in patients with PT >2.0. ROTEM with the ExTEM reagent alongside high and low doses of APCC resulted in a significant shortening of median CT, both compared to baseline (100 s) and after low (65 s) and high doses (57 s). Results: The ROTEM EXTEM CT was prolonged beyond the upper normal range of 68 s in patients with PT >3.0, with a correlation coefficient of 0.88 to PT. The effects of two separate doses of APCC added in vitro corresponding to in vivo doses of 50 IE or 100 IE/kg were then studied on the ROTEM. Two concentrations of tissue factor ROTEM tissue factor (TF) activating reagents were used: a standard ROTEM ExTEM and a diluted 1:19000 concentration. Method: During the routine control of PT in 27 patients treated with warfarin, one extra 4.5 ml test tube of citrated whole blood was retrieved. The aim of this study was to investigate the ability of ROTEM to monitor the in vitro reversal of warfarin-induced coagulopathy using APCC and to define an APCC dose response. A previous in vitro study found that activated prothrombin complex concentrates (APCC) could reverse an albumin-induced coagulopathy monitored with ROTEM, but that prothrombin complex concentrates (PCC) could not. Background: Warfarin-treated patients with a prolonged Prothrombin Time (PT) can have a normal rotational thromboelastometry (ROTEM) clotting time (CT). ![]()
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