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Warfarin monitoring with viscoelastic haemostatic assays, thrombin generation, coagulation factors and correlations to Owren and Quick prothrombin time.

Authors
  • Nilsson, Caroline U1
  • Strandberg, Karin2
  • Reinstrup, Peter1
  • 1 a Department of Anesthesia and Intensive Care , Clinical Sciences Lund, Lund University, Sweden and Skåne University Hospital Lund , Lund , Sweden. , (Sweden)
  • 2 b Department of Laboratory Medicine , Lund University and Skåne University Hospital Malmö , Malmö , Sweden. , (Sweden)
Type
Published Article
Journal
Scandinavian Journal of Clinical and Laboratory Investigation
Publisher
Informa UK (Taylor & Francis)
Publication Date
Sep 01, 2018
Volume
78
Issue
5
Pages
358–364
Identifiers
DOI: 10.1080/00365513.2018.1474492
PMID: 29792060
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The anticoagulant warfarin is commonly monitored with prothrombin time (PT). Viscoelastic haemostatic assays (VHA) are primarily used in situations of acute bleeding to guide haemostatic therapy. Much research has focused on VHA monitoring of new oral anticoagulants. However, many patients are still anticoagulated with warfarin and effect of warfarin anticoagulation on VHA is uncertain. The aim of this study was to assess warfarin anticoagulation on three different VHA and compare these findings with prothrombin time (PT), coagulation factor analyses and a thrombin generation assay (TGA). Citrated whole blood was drawn from 80 patients admitted for routine PT-INR Owren. VHA analysis with ROTEM (EXTEM, INTEM and FIBTEM), ReoRox (Fibscreen 1 and 2) and Sonoclot (gbACT+) was performed. Blood was also drawn for plasma analysis with PT (PT-INR Owren and PT Quick), TGA and analysis of factors I, II, VII, IX and X. Extrinsically activated VHA, including ROTEM EXTEM and FIBTEM Clotting Time (CT) and ReoRox Fibscreen1 and 2 clot onset time 1 correlated moderately with PT-INR Owren , with R 0.66-0.71. These four variables were likely to be prolonged above reference interval in patients with prolonged PT-INR Owren >1.2. Two patients with normal ROTEM CTs had Owren PT-INRs >1.5. Warfarin affects extrinsically activated VHA variables of initial clotting. The role of VHA for clinical decision-making in patients planned for invasive procedures, such as spinal/epidural anaesthesia needs further study. None of the recent guidelines on regional anaesthesia include VHA testing to define adequate haemostasis.

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