دورية أكاديمية
Monitoring of Argatroban in Critically Ill Patients: A Prospective Study Comparing Activated Partial Thromboplastin Time, Point-of-Care Viscoelastic Testing with Ecarin Clotting Time and Diluted Thrombin Time to Mass Spectrometry.
| العنوان: | Monitoring of Argatroban in Critically Ill Patients: A Prospective Study Comparing Activated Partial Thromboplastin Time, Point-of-Care Viscoelastic Testing with Ecarin Clotting Time and Diluted Thrombin Time to Mass Spectrometry. |
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| المؤلفون: | Heubner L; Department of Anesthesiology and Intensive Care Medicine, University Hospital 'Carl Gustav Carus,' Technische Universität Dresden, Dresden, Germany., Oertel R; Institute of Clinical Pharmacology, Faculty of Medicine, University Hospital 'Carl Gustav Carus,' Technische Universität Dresden, Dresden, Germany., Tiebel O; Institute of Clinical Chemistry, University Hospital 'Carl Gustav Carus,' Technische Universität Dresden, Dresden, Germany., Mehlig-Warnecke N; Department of Anesthesiology and Intensive Care Medicine, University Hospital 'Carl Gustav Carus,' Technische Universität Dresden, Dresden, Germany., Beyer-Westendorf J; Division of Hematology and Hemostasis, Department of Medicine I Thrombosis Research, University Hospital 'Carl Gustav Carus,' Technische Universität Dresden, Dresden, Germany., Mirus M; Department of Anesthesiology and Intensive Care Medicine, University Hospital 'Carl Gustav Carus', Technische Universität Dresden, Dresden, Germany., Roessler M; BARMER Institut für Gesundheitssystemforschung, Berlin, Germany., Renner B; Institute of Clinical Pharmacology, Faculty of Medicine, University Hospital 'Carl Gustav Carus,' Technische Universität Dresden, Dresden, Germany., Spieth PM; Department of Anesthesiology and Intensive Care Medicine, University Hospital 'Carl Gustav Carus,' Technische Universität Dresden, Dresden, Germany. |
| المصدر: | Anesthesiology [Anesthesiology] 2024 Feb 01; Vol. 140 (2), pp. 261-271. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 1300217 Publication Model: Print Cited Medium: Internet ISSN: 1528-1175 (Electronic) Linking ISSN: 00033022 NLM ISO Abbreviation: Anesthesiology Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Philadelphia Pa : Lippincott Williams & Wilkins Original Publication: Philadelphia : American Society of Anesthesiologists |
| مواضيع طبية MeSH: | Sepsis*/drug therapy , Thrombophilia*, Humans ; Partial Thromboplastin Time ; Thrombin Time ; Prospective Studies ; Critical Illness ; Point-of-Care Systems ; Bayes Theorem ; Antithrombins/therapeutic use ; Anticoagulants/therapeutic use ; Heparin ; Mass Spectrometry |
| مستخلص: | Background: 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 (PTT) or diluted thrombin time (TT), both of which have limitations in patients with hypercoagulability. Methods: Blood samples were obtained from critically ill patients treated with argatroban. Activated PTT and diluted TT were measured with a STA R Max3 analyzer (STAGO Deutschland GmbH, Germany) using an argatroban-calibrated kit. Ecarin clotting time was measured using a point-of-care viscoelastic test device. Liquid chromatography with tandem mass spectrometry was performed using a reversed-phase column, a solvent gradient, and an API4000 mass spectrometer with electrospray. Correlation was described using Pearson correlation coefficient r and Bayesian multilevel regression to estimate relationships between outcomes and covariates. Results: From June 2021 to March 2022, 205 blood samples from 22 patients were analyzed, allowing for 195 activated PTT-liquid chromatography with tandem mass spectrometry comparisons, 153 ecarin clotting time-liquid chromatography with tandem mass spectrometry comparison, and 105 diluted TT-liquid chromatography with tandem mass spectrometry comparisons. Compared to liquid chromatography with tandem mass spectrometry, performance of argatroban quantification was best for diluted TT (r = 0.91), followed by ecarin clotting time (r = 0.58) and activated PTT (r = 0.48). Regression analysis revealed that patients with sepsis were more prone to argatroban overdosing (coefficient, 4.194; 95% credible interval, 2.220 to 6.792). Conclusions: Although activated PTT monitoring of argatroban is the most commonly used test, in critically ill patients, diluted TT provides more precise measurements. Alternately, point-of-care viscoelastic ecarin clotting time also provides guidance for argatroban dosing to identify overdosing if available. The data also suggested that patients with sepsis are at greater risk for argatroban overdosing. (Copyright © 2023 American Society of Anesthesiologists. All Rights Reserved.) |
| المشرفين على المادة: | IY90U61Z3S (argatroban) EC 3.4.24.- (ecarin) 0 (Antithrombins) 0 (Anticoagulants) 9005-49-6 (Heparin) |
| تواريخ الأحداث: | Date Created: 20231003 Date Completed: 20240110 Latest Revision: 20240110 |
| رمز التحديث: | 20240110 |
| DOI: | 10.1097/ALN.0000000000004787 |
| PMID: | 37787760 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1528-1175 |
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| DOI: | 10.1097/ALN.0000000000004787 |