What question did this study set out to answer?

April 1, 2004American Journal of Clinical Pathology

Effect of Direct Thrombin Inhibitors, Bivalirudin, Lepirudin, and Argatroban, on Prothrombin Time and INR Values

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Why the study?

How do different direct thrombin inhibitors (bivalirudin, lepirudin, argatroban) affect INR values across various PT reagents in pooled plasma?

Population

Pooled plasma

Comparison

Direct thrombin inhibitors at concentrations… vs Comparison between different direct thrombin…

Design

Preclinical

Authors

RGRobert C. GosselinGhent University Hospital WDWilliam E. DagerUniversity of California, San Francisco JKJeffrey H. KingUniversity of California Davis Medical Center

Discussion

Member takes

Implication

Variable INR effects by DTI and reagent may complicate monitoring; leaves open clinical relevance for transitioning patients to coumarins.

Key Points

To evaluate and compare the impact of the direct thrombin inhibitors bivalirudin, lepirudin, and argatroban on prothrombin time and international normalized ratio (INR) values across multiple laboratory reagents.
Added bivalirudin, lepirudin, or argatroban to pooled normal plasma at concentrations ranging between 0.1 and 1.2 μg/mL.
Concurrently measured prothrombin time and INR values using 14 different commercial prothrombin time reagents.
Evaluated differences in median INR responses using repeated measures analysis of variance.
Significant differences (P < .05) in median INRs occurred between lepirudin and argatroban across all 14 reagents, between lepirudin and bivalirudin for 13 of 14 reagents (P = .07 for PT-Fibrinogen HS Plus), and between bivalirudin and argatroban for 13 of 14 reagents (P = .05 for Thromborel S).
INR prolongation was drug-, concentration-, and reagent-dependent, with argatroban exerting the strongest effect and lepirudin having the least effect.
Reagents with lower international sensitivity index values demonstrated lower susceptibility to direct thrombin inhibitors, with ThromboMax HS being the least sensitive reagent overall.

Structured PICO

How do different direct thrombin inhibitors (bivalirudin, lepirudin, argatroban) affect INR values across various PT reagents in pooled plasma?

Population

Pooled plasma

Intervention

Direct thrombin inhibitors (bivalirudin, lepirudin, argatroban) at concentrations between 0.1 and 1.2 μg/mL

Comparator

Comparison between different direct thrombin inhibitors and across 14 prothrombin time (PT) reagents

Outcome

Effect on international normalized ratio (INR) valuessurrogate

Direct thrombin inhibitors artificially prolong INR values to varying degrees depending on the specific drug, concentration, and PT reagent used, which complicates transitioning patients to coumarins.

Cite This Study

Gosselin et al. (2004) studied this question.

synapsesocial.com/papers/6a8732b4540b033b21bf1316 https://doi.org/10.1309/d79k4yg78ntnyy38

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Implication

Variable INR effects by DTI and reagent may complicate monitoring; leaves open clinical relevance for transitioning patients to coumarins.

Effect of Direct Thrombin Inhibitors, Bivalirudin, Lepirudin, and Argatroban, on Prothrombin Time and INR Values

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Effect of Direct Thrombin Inhibitors, Bivalirudin, Lepirudin, and Argatroban, on Prothrombin Time and INR Values

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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