凝血活酶敏感指数对凝血酶原时间测定的影响

目的:了解不同国际敏感指数(ISI)的凝血活酶试剂对凝血酶原时间(PT)测定的影响。方法:在相同条件下,使用3种不同的ISI值的凝血活酶试剂,对20例正常人,30例确诊为消化道肿瘤的病人及32例心脏外科行瓣膜置换术后口服抗凝药的病人进行测定。结果:病人组的3种ISI值的凝血酶原时间(PT)有显著性差异(P＜0.01),国际标准化比率(INR)无显著性差异(P＞0.05)。结论:ISI是PT测定标准化的重要因素。     

凝血酶原时间测定标准化的应用

凝血酶原时间(PT)测定是检查机体外源性凝血系统功能有无障碍的过筛试验,也是临床抗凝治疗的重要检测指标[1]。影响PT的因素很多,各实验室之间甚至实验室内测定的结果有很大差异,无可比性。为求统一标准,ICTH和ICSH提出用国际敏感指数(ISI)标记凝血活酶,并采用国际标准化比率(I     

凝血酶原时间检测的进展

凝血酶原时间(Prothrombin time，PT)测定广泛应用于疾病的诊断和治疗，尤其是抗凝治疗的监测，1975年ICSH公布了PT检测的参考方法，近年又引入凝血活酶试剂的国际敏感指数(international sensitivity index，ISI）和国际参考制剂(international reference     

不同抗凝比血浆凝血试验结果在临床上的应用

为了探讨不同抗凝比血浆凝血试验结果之间的差异及能否运用于临床，笔者收集了不同抗凝比例的血浆，同时做凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)测定，并将其结果进行比较，现报道如下：     

PT衍生法测定纤维蛋白原在CA1500上的应用

目的 :探讨 CA15 0 0全自动凝血仪上 PT衍生法 (PT- der法 )测定 Fbg的准确性 ,以推广 PT衍生法在 CA 15 0 0仪上的合理应用。方法 :采用 Dade公司试剂在 CA15 0 0上测定 PT取得 Fbg衍算值同时与 clauss法测定值相比较 ;探讨 PT- der法在 CA 15 0 0上可信范围。结果 :应用 PT- der法测定 Fbg重复性良好 ,批内 CV=0 .0 35。对 113份标本分别用 PT-der法与 clauss法进行测定 ,结果显示 1.5 0～ 2 .99g/ L的 Fbg测定值两种方法结果相近 ,当 Fbg>3.0 g/ L时 ,PT- der法结果与 clauss法有极显著差异 ,PT- der法结果明显偏高。结论 :当 PT- der法换算出的 Fbg值在 1.5 0～ 2 .99g/ L之间时 ,结果可靠 ,完全可以替代 clauss法测定 Fbg,从而达到节省试剂的目的 ,当 PT- der换算值 >3.0 g/ L时 ,结果偏高 ,必须用clauss法进行 Fbg的测定 ,以免误导临床。     

INRatio快速血凝分析仪检测国际标准化比值的临床应用价值

目的 比较INRatio快速血凝分析仪与标准实验室静脉血测定的国际标准化比值(INR)之间的相关性和一致性,判断INRatio快速血凝分析仪检测INR的临床应用价值.方法 选择100例口服华法林患者.同时抽取静脉血及指端末梢血,分别行标准SYSMEX CA-7000全自动凝血仪INR测定及INRatio快速血凝分析仪INR测定.比较两组结果的相关性、一致性.结果 当测量INR≤5时,INRatio快速血凝分析仪和SYSMEX CA-7000全自动凝血仪之间显示了良好的相关性(r=0.898,P=0.000);两种方法总体平均值偏倚差值为0.36,INRatio快速血凝分析仪比 SYSMEXCA-7000全自动凝血仪检测值高;通过Bland-Altman分析,两种方法INR平均值在1.60～3.50时,91.2％(62/68)的点在95％的一致性限度内,一致性良好;两种方法INR平均值＞3.50时,仅50.0％(1/2)的点在95％的一致性限度内,一致性差.结论 在治疗范围内,INRatio快速血凝分析仪检测的结果表现出与标准实验室结果良好的相关性和一致性,可以应用于临床对口服抗凝药患者INR的检测.     

普利生凝血试剂在Sysmex CA-530全自动血凝仪上的应用评价

目的 :比对国产普利生凝血试剂与原装进口Siemens试剂在日本Sysmex CA-530全自动血凝仪上使用结果有无显著差异。方法:分别用普利生凝血酶时间(prothrombin time,PT)和活化部分凝血活酶时间(actived partial thromboplastin time,APTT)测定试剂与原装Siemens试剂检测临床标本,统计结果后进行分析。结果:国产普利生PT和APTT测定试剂与原装Siemens试剂检测结果无显著差异,PT、国际化标准比率(international normalized,INR)与APTT值偏差均符合美国CLIA’88标准要求。结论:国产普利生PT和APTT测定试剂与原装试剂相关性良好,可以替代Siemens试剂在Sysmex CA-530全自动血凝仪上使用。     

凝血酶原时间测定在乙型病毒性肝炎患者中的临床应用

目的　了解凝血酶原时间(PT)、国际标准化比值(INR)及凝血酶原活动度(PTA) 3项指标在乙型病毒性肝炎(乙肝)各型患者中的分布情况,及血清丙氨酸转氨酶(ALT)对乙肝患者诊断和治疗的指导作用。方法　对某院5 33例乙肝患者及4 0例健康对照者(对照组) ,采用ACL 2 0 0型凝血仪及配套试剂测定PT ,INR及PTA值,采用贝克曼CX 9生化仪及配套试剂测定ALT值;数据以平均数和标准差进行方差分析和q检验。结果　PT ,INR ,PTA及ALT在对照组和各型乙肝患者组经方差分析,差异有统计学意义(P <0 .0 1) ;在各型乙肝患者组经q检验,两两比较分析其组间差异性,PTA ,INR及ALT比PT更多见。结论　PT ,INR ,PTA及ALT 4项指标可以反映乙肝患者病情的严重程度,也可作为其病程变化和预后的指标。     

临产妇血浆凝血指标检测的临床意义

目的:了解临产妇血浆凝血指标与正常对照组血浆凝血因子的数值变化情况。方法:利用血凝仪进行血浆凝血酶原时间(PT)、国际标准化比值(INR)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)及凝血酶时间(TT)检测。结果:血浆PT、INR值、APTT明显低于正常对照组(P0.05),FIB含量非常显著高于正常对照组(P0.01),而TT与正常对照组比较差异无统计学意义(P0.05)。结论:通过对临产妇血浆凝血指标的检测,了解临产妇的凝血功能状态,防止产妇大出血、胎盘早剥、胎盘潴留、前置胎盘、羊水栓塞等的发生,避免局部形成纤维蛋白凝块或血栓的形成以及DIC等的发生。     

凝血酶原时间和活化部分凝血活酶时间正常参考值测定的探讨

凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)是判断机体止血与凝血系统病理变化的两项重要指标，也是临床溶栓、抗凝治疗及手术前的必要检查项目。因仪器、试剂不同，会得出不同结果，故很难统一规定参考值。各实验室可根据自己的仪器，试剂等条件自行测定一批健康人建立参考值。为此，我们收集了200份健康人标本，在本实验室常规条件下，利用Sysmex CA-6000全自动血凝分析仪，应用统计学方法对本实验室PT、APTT两项指标的正常参考值进行测定。现报告如下：     

超高效液相色谱法测定血浆华法林浓度及临床应用

目的建立超高效液相色谱法(ultra performance liquid chromatography,UPLC)测定血浆华法林浓度,探讨心脏换瓣术后患者华法林血药浓度与国际标准化比率(international normalized ratio,INR)测值的关系,以寻求更安全可靠的监测指标,指导临床抗凝治疗的合理用药。 方法利用6-甲氧基萘乙酸作为内标,建立一种超高效液相色谱法,测定血浆中的华法林浓度。同时对79例样本的INR、华法林剂量和血浆华法林浓度进行相关性分析。 结果华法林和内标的保留时间分别是2.2和1.1 min,血浆中华法林的平均提取回收率为96.0%,华法林浓度在15.6~4000 ng/ml具有良好的线性(R²=0.9996),方法回收率为98.5%~99.9%,最低检测限为5.0 ng/ml。日内和日间精密度分别低于1.34%和2.69%。79例患者INR和华法林剂量相关性为r²=0.006(P=0.481),INR和血浆华法林浓度为r²=0.006(P=0.497),华法林剂量和血浆浓度相关性为r²=0.298(P=0.001)。 结论该方法是一种简便、快速、准确、灵敏的定量测定人体血浆中华法林浓度的UPLC方法,华法林血药浓度测定对于心脏瓣膜置换手术后患者的抗凝治疗具有指导意义。     

子痫前期－子痫时胰岛素抵抗与血清瘦素水平的关系

目的 探讨子痫前期－子痫时胰岛素抵抗与血清瘦素水平的关系。方法 选取子痫前期－子痫时患者36例为研究组,其中子痫前期轻度20例,重度子痫前期／子痫16例,对照组随机选择同期入院分娩的28例正常孕妇,测定两组患者身高、体重、血糖、胰岛素、血清瘦素水平及胰岛素敏感指数。结果 子痫前期－子痫患者血清瘦素及胰岛素水平明显高于对照组（t值分别为9．55、3．61,均P＜0．05）,尤其是重度子痫前期及子痫患者血清瘦素水平明显高于对照组（t＝35．55,P＝0．000）,而胰岛素敏感指数显著低于对照组（t＝2．35,P＝0．022）。子痫前期－子痫患者血糖水平与对照组无显著性差异（t＝0．65,P＝0．780）。结论 子痫前期－子痫患者血清瘦素水平高低与疾病的严重程度成正相关关系,对预测子痫前期－子痫时的发生有一定临床意义。检测血清瘦素、胰岛素及胰岛素敏感指数对预防子痫前期－子痫的发生有重要意义。     

他汀类药物对华法林抗凝强度的影响研究

目的 分析他汀类药物对华法林抗凝强度的影响,为临床合理用药提供参考依据.方法 统计河北省人民医院2019年1月～8月所有使用华法林的门诊处方,抽取联合用药的处方进行整理,分析他汀类药物对华法林抗凝强度的影响.结果 华法林合用他汀类药物处方共189张,联合使用氟伐他汀、辛伐他汀及瑞舒伐他汀前后INR差异均具有统计学意义(...     

A retrospective survey on practice of oral anticoagulant therapy in patients with cardiovascular diseases

INTRODUCTION: Recently there are several evidence based facts about the beneficial effect of oral anticoagulant therapy in patients with cardiovascular diseases. In the other hand the often serious bleeding complications as well as the ineffective antithrombotic therapy should be avoided. AIM AND METHODS: Authors had examined with a questionnaire some characteristic parameters of oral anticoagulant therapy in Hungarian hospitals. Based on the results they carried out a retrospective survey (488 consecutive patients) on the accuracy and other peculiarity of long-term acenocoumarol therapy in the district of County Hospital Gyula. RESULTS AND CONCLUSIONS: Mean value of all coagulation test's results (INR: 2.72 +/- 1.07, prothrombin %: 36.11 +/- 10.52) suggest a relatively favourable therapeutic activity in the patients required acenocoumarol therapy. According to their data the proportion of newly introduced anticoagulant therapy secondary to atrial fibrillation was highly increased (42%). They stated that the accuracy of documentation in conducting of oral anticoagulant therapy should be improved and it would be the time to use obligatory the INR value in the clinical practice. They found the best therapeutic punctuality among the patients controlled in the Special Cardiological Outpatient Department. There were relatively few event of serious bleedings. The authors called attention to the patients (about 5%) who were treated without any special cause for a longer period of time than it was necessary. They emphasize the pivotal role of permanent education of patients and the importance of their therapeutic compliance in the appropriate oral anticoagulant control.     

Telemedicine improves the monitoring process in anticoagulant treatment

We compared the INR (International Normalized Ratio) monitoring process using a telemedicine device with the conventional approach in which blood samples were sent to the hospital for analysis. We conducted a randomized controlled trial. We enrolled 40 patients on chronic warfarin therapy from two primary healthcare centres (PHCs). Half were monitored using the telemedicine device and half were monitored conventionally. Each patient received three INR measurements. The total processing time was measured from blood sampling until warfarin dosing was performed in the anticoagulant clinic. The median total processing time was significantly shorter with telemedicine than usual care (34 vs. 260 min, P < 0.001). This was mainly because sample transport was avoided using the point-of-care device and automatic data transmission. Telemedicine reduced the total processing time for INR monitoring and has the potential to improve the management of patients undergoing anticoagulant treatment at PHCs.     

Relationship between diet and anticoagulant response to warfarin

Background Diet composition is one of the factors that may contribute to intraindividual variability in the anticoagulant response to warfarin. Aim of the study To determine the associations between food pattern and anticoagulant response to warfarin in a group of Brazilian patients with vascular disease. Methods Recent and usual food intakes were assessed in 115 patients receiving warfarin; and corresponding plasma phylloquinone (vitamin K₁), serum triglyceride concentrations, prothrombin time (PT), and International Normalized Ratio (INR) were determined. A factor analysis was used to examine the association of specific foods and biochemical variables with anticoagulant data. Results Mean age was 59 ± 15 years. Inadequate anticoagulation, defined as values of INR 2 or 3, was found in 48% of the patients. Soybean oil and kidney beans were the primary food sources of phylloquinone intake. Factor analysis yielded four separate factors, explaining 56.4% of the total variance in the data set. The factor analysis revealed that intakes of kidney beans and soybean oil, 24-h recall of phylloquinone intake, PT and INR loaded significantly on factor 1. Triglycerides, PT, INR, plasma phylloquinone, and duration of anticoagulation therapy loaded on factor 3. Conclusions Fluctuations in phylloquinone intake, particularly from kidney beans, and plasma phylloquinone concentrations were associated with variation in measures of anticoagulation (PT and INR) in a Brazilian group of patients with vascular disease. This material is based upon work supported by CNPq and by federal funds from the U.S. Department of Agriculture, Agricultural Research Service under Cooperative Agreement No. 58-1950-001 and No. 58-1950-4-401. Any opinions, findings, conclusions or recommendations expressed in this publication are those of the authors, and do not necessarily reflect the view of the U.S. Department of Agriculture. An erratum to this article is available at .     

Prolonged diminished effect of coumarin derivatives after use of rifampicin

A 73-year-old woman with endocarditis was treated with flucloxacillin and rifampicin. She already used the anticoagulant acenocoumarol because of a recent heart valve replacement. After starting rifampicin therapy the sensitivity for the acenocoumarol was reduced. The international normalised ratio (INR) did not exceed 2.0, while values of 2.5-3.5 were required. Increase of the daily dose of acenocoumarol with a factor 6 compared to the dose which resulted in a therapeutic INR before hospitalisation, proved insufficient to obtain a therapeutic INR during long-term rifampicin therapy. 21 days after rifampicin discontinuation the INR finally responded to high coumarin dosages. The breakdown of coumarins in the liver is increased by rifampicin due to induction of several isoenzymes of the cytochrome P450-system. This case illustrates that sensitivity to coumarins can be decreased profoundly even after discontinuation of rifampicin therapy. INR should be monitored closely not only at the start and discontinuation of rifampicin therapy, but also during the weeks after discontinuation of rifampicin treatment.     

Patients' perspectives on self-testing of oral anticoagulation therapy: Content analysis of patients' internet blogs

Background  

Patients on oral anticoagulant therapy (OAT) require regular testing of the prothrombin time (PT) and the international normalised ratio (INR) to monitor their blood coagulation level to avoid complications of either over or under coagulation. PT/INR can be tested by a healthcare professional or by the patient. The latter mode of the testing is known as patient self-testing or home testing. The objective of this study was to elicit patients' perspectives and experiences regarding PT/INR self-testing using portable coagulometer devices.