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Correlation of Point-of-Care ecarin clotting time versus activated clotting time with bivalirudin concentrations

      To rapidly and specifically monitor the anticoagulant effect of direct thrombin inhibitors, a thrombin inhibitor management (TIM) point-of-care test was developed (PharmaNetics, Inc., Morrisville, North Carolina), based upon the ecarin clotting time (ECT). This method utilizes the enzyme ecarin (from the venom of Echis carinatus) to convert prothrombin to meizothrombin. Meizothrombin catalyzes the conversion of fibrinogen to fibrin and is rapidly inhibited by direct thrombin inhibitors, such as bivalirudin. This assay has the particular advantage of being relatively specific for the effect of direct thrombin inhibitors, because heparins are poor inhibitors of meizothrombin.
      • Nowak G.
      • Bucha E.
      Quantitative determination of hirudin in blood and body fluids.
      ,
      • Moser M.
      • Ruef J.
      • Peter K.
      • Kohler B.
      • Gulba D.C.
      • Paterna N.
      • Nordt T.
      • Kubler W.
      • Bode C.
      Ecarin clotting time but not aPTT correlates with PEG-hirudin plasma activity.
      The TIM-ECT test card may provide a more accurate measurement of direct thrombin inhibitor activity than current point-of-care assays. The purpose of this study was to compare the TIM-ECT test and 2 available activated clotting time (ACT) methods with a central laboratory anti-Factor IIa assay for monitoring bivalirudin-mediated anticoagulation.
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      References

        • Nowak G.
        • Bucha E.
        Quantitative determination of hirudin in blood and body fluids.
        Semin Thromb Hemost. 1996; 22: 197-202
        • Moser M.
        • Ruef J.
        • Peter K.
        • Kohler B.
        • Gulba D.C.
        • Paterna N.
        • Nordt T.
        • Kubler W.
        • Bode C.
        Ecarin clotting time but not aPTT correlates with PEG-hirudin plasma activity.
        J Thromb Thrombolysis. 2001; 12: 165-169
        • Bull M.H.
        • Huse W.M.
        • Bull B.S.
        Evaluation of tests used to monitor heparin therapy during extracorporeal circulation.
        Anesthesiology. 1975; 43: 346-353
        • Granger C.B.
        • Moliterno D.J.
        Bedside anticoagulant testing.
        in: Topol E.J. Acute Coronary Syndromes. Marcel Dekker, New York, NY2000: 541-562
        • Rath B.
        • Bennett D.H.
        Monitoring the effect of heparin by measurement of activated clotting time during and after percutaneous transluminal coronary angioplasty.
        Br Heart J. 1990; 63: 18-21
        • Lucas F.V.
        • Duncan A.
        • Jay R.
        • Coleman R.
        • Craft P.
        • Chan B.
        • Winfrey L.
        • Mungall D.R.
        • Hirsh J.
        A novel whole blood capillary technic for measuring the prothrombin time.
        Am J Clin Pathol. 1987; 88: 442-446
      1. Lindhoff-Last E, Bauersachs R, Mosch G, Piechottka G, Rabe F, Ehrly A. A chromogenic method for the determination of hirudin in plasma. Gesellschaft für Thrombose-und Hämostaseforschung at www.diapharma.com/methods/ diapharma-mp-hirudin.htm

        • Nowak G.
        Clinical monitoring of hirudin and direct thrombin inhibitors.
        Semin Thromb Hemost. 2001; 27: 537-541
        • Rao A.K.
        • Pratt C.
        • Berke A.
        • Jaffe A.
        • Ockene I.
        • Schreiber T.L.
        • Bell W.R.
        • Knatterud G.
        • Robertson T.L.
        • Terrin M.L.
        Thrombolysis in Myocardial Infarction (TIMI) Trial—phase I. hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase.
        J Am Coll Cardiol. 1988; 11: 1-11
        • Bittl J.A.
        • Strony J.
        • Brinker J.A.
        • Ahmed W.H.
        • Meckel C.R.
        • Chaitman B.R.
        • Maraganore J.
        • Deutsch E.
        • Adelman B.
        Treatment with bivalirudin (Hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. Hirulog Angioplasty Study Investigators.
        N Engl J Med. 1995; 333: 764-769
        • Bittl J.A.
        • Chaitman B.R.
        • Feit F.
        • Kimball W.
        • Topol E.J.
        Bivalirudin versus heparin during coronary angioplasty for unstable or postinfarction angina.
        Am Heart J. 2001; 142: 952-959
        • Lincoff A.M.
        • Kleiman N.S.
        • Kottke-Marchant K.
        • Maierson E.S.
        • Maresh K.
        • Wolski K.E.
        • Topol E.J.
        Bivalirudin with planned or provisional abciximab versus low-dose heparin and abciximab during percutaneous coronary revascularization.
        Am Heart J. 2002; 143: 847-853