Global assays and the management of oral anticoagulation
- Herm Jan M Brinkman
- Thrombosis journal
A chromogenic prothrombin time (CPT) has been compared with the standard prothrombin time (PT) or activated partial thromboplastin time (aPTT) in evaluating the hemostatic abnormality in patients with specific clotting factor deficiencies or liver disease and in patients receiving anticoagulant or fibrinolytic therapy. As expected, the CPT was sensitive to deficiencies of Factors II, V, X, and VII but was unaffected by deficiencies of Factors XII, XI, IX, or VIII. Due to the presence of polybrene in the thromboplastin formulation, the CPT was insensitive to heparin concentrations below 1 unit/mL. However, the assay result prolonged progressively between 1 and 10 units of heparin/mL, indicating that the CPT can be used to assay heparin concentrations within this range. Among patients with liver disease or who were receiving warfarin or fibrinolytic therapy, there was good correlation between the prolongation of the PT and the CPT. The results demonstrate that the CPT was sensitive to the commonly encountered clinical abnormalities in which the PT is prolonged and could be applied for monitoring oral anti-coagulant therapy. However, prolongation of the PT to a given value in different clinical conditions was associated with different degrees of prolongation of the CPT. This differential effect may reflect an abnormality in fibrinogen conversion to fibrin, which prolongs the PT but not the CPT and may also be contributed to by the differential sensitivity of the PT and CPT to specific factor deficiencies. The simplicity and reproducibility of the CPT warrant its further assessment, but correlation with the PT in a variety of clinical conditions is needed before clinical application can be undertaken.