Monitoring of argatroban in critically ill patients: a prospective study comparing aPTT, point-of-care viscoelastic testing with ecarin clotting time and dTT to mass spectrometry

阿加曲班 医学 凝血时间激活 凝血酶时间 部分凝血活酶时间 肝素 药理学 麻醉 内科学 凝结 凝血酶 血小板
作者
Lars Heubner,Reinhard Oertel,Oliver Tiebel,Nicole Mehlig-Warnecke,Jan Beyer‐Westendorf,Martin Roessler,Bertold Renner,Peter Spieth
出处
期刊:Anesthesiology [Lippincott Williams & Wilkins]
标识
DOI:10.1097/aln.0000000000004787
摘要

The direct thrombin inhibitor argatroban is indicated for the treatment of heparin-induced thrombocytopenia II, but it is also used off-label to treat critically ill patients presenting with heparin resistance, severe antithrombin deficiency or hypercoagulability. Direct drug monitoring is not routinely available and argatroban dosing is mainly based on global coagulation assays such as activated partial thromboplastin time (aPTT) or diluted thrombin time (dTT), both of which have limitations in patients with hypercoagulability.Blood samples were obtained from critically ill patients treated with argatroban, aPTT and dTT were measured with a STA R Max3-Analyzer using an argatroban-calibrated kit. Ecarin clotting time (ECA-CT) was measured using a POC viscoelastic test device. Liquid chromatography with tandem mass spectrometry (LC/MS/MS) was performed using a reversed phase column, a solvent gradient and a API4000 mass spectrometer with electrospray. Correlation was described using Pearson correlation coefficient r and Bayesian multilevel regression to estimate relationships between outcomes and covariates.From 06/2021 to 03/2022, 205 blood samples from 22 patients were analyzed, allowing for 195 aPTT - LC/MS/MS comparisons, 153 ECA-CT - and 105 dTT - LC/MS/MS comparisons. Compared to LC/MS/MS, performance of argatroban quantification was best for dTT (r =0.91), followed by ECA-CT (r=0.58) and aPTT (r=0.48). Regression analysis revealed that patients with sepsis were more prone to argatroban overdosing (coefficient: 4.194; 95% Crl 2.220, 6.792).Althought aPTT monitoring of argatroban is the most commonly used test, in critically ill patients dTT provides more precise measurements. Alternately, point-of-care viscoelastic ECA-CT also provides guidance for argatroban dosing to identify overdosing if available. Our data also suggests patients with sepsis are at a greater risk for argatroban overdosing.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
酷波er应助loong采纳,获得10
1秒前
搜集达人应助肖珂采纳,获得10
2秒前
jinjinshan完成签到,获得积分10
3秒前
典雅的觅儿完成签到,获得积分10
3秒前
大喵发布了新的文献求助10
4秒前
4秒前
莉莉娅完成签到 ,获得积分10
6秒前
一丁雨完成签到,获得积分10
7秒前
7秒前
ll完成签到,获得积分10
8秒前
自由的梦露完成签到,获得积分10
8秒前
绿泡泡发布了新的文献求助10
9秒前
莉莉娅关注了科研通微信公众号
9秒前
9秒前
10秒前
J.关闭了J.文献求助
10秒前
TT木木发布了新的文献求助10
13秒前
孤独的大灰狼完成签到 ,获得积分10
14秒前
酷波er应助乂贰ZERO叁采纳,获得10
14秒前
16秒前
18秒前
TTTaT完成签到,获得积分10
18秒前
在水一方应助泥嚎采纳,获得10
18秒前
悟空应助开心岩采纳,获得50
19秒前
小龙完成签到,获得积分10
19秒前
mutongchen完成签到,获得积分10
19秒前
然大宝发布了新的文献求助10
20秒前
20秒前
麦子发布了新的文献求助10
21秒前
21秒前
21秒前
yufei完成签到,获得积分20
22秒前
wenbaka完成签到 ,获得积分10
22秒前
J.关闭了J.文献求助
24秒前
Jasper应助绿泡泡采纳,获得10
27秒前
WRZ完成签到,获得积分10
27秒前
黑色土豆发布了新的文献求助200
27秒前
九粒发布了新的文献求助10
27秒前
bkagyin应助乱武采纳,获得10
27秒前
28秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989797
求助须知:如何正确求助?哪些是违规求助? 3531910
关于积分的说明 11255394
捐赠科研通 3270563
什么是DOI,文献DOI怎么找? 1805008
邀请新用户注册赠送积分活动 882157
科研通“疑难数据库(出版商)”最低求助积分说明 809190