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The fibrinogen prothrombin time‐derived method is not useful in patients anticoagulated with low molecular weight heparins or rivaroxaban
Author(s): ,
C. Duboscq
Affiliations:
Servcio de Hematología Hospital Británico de Buenos Aires, Buenos Aires, Argentina
Correspondence: Cristina Duboscq, Servcio de Hematología Hospital Británico de Buenos Aires, Buenos Aires, Argentina|Tel.: +54 11 4304 1082 (ext 2571)|E‐mails: ; cduboscq@hbritanico.com
,
M. E. Martinuzzo
Affiliations:
Grupo Bioquímico, Laboratorio Central del Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
,
J. Ceresetto
Affiliations:
Servcio de Hematología Hospital Británico de Buenos Aires, Buenos Aires, Argentina
,
M. Lopez
Affiliations:
Grupo Bioquímico, Laboratorio Central del Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
,
L. Barrera
Affiliations:
Grupo Bioquímico, Laboratorio Central del Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
,
J. Oyhamburu
Affiliations:
Grupo Bioquímico, Laboratorio Central del Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
G. Stemmelin
Affiliations:
Servcio de Hematología Hospital Británico de Buenos Aires, Buenos Aires, Argentina
ISTH Academy. Duboscq C. Aug 2, 2018; 227427
Dr. Cristina Duboscq
Dr. Cristina Duboscq

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Journal Abstract
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Background
The fibrinogen prothrombin time‐derived (FIBPT‐d) method with photo‐optical coagulometers is easy and economical. However, there are few reports on the behavior of this test on samples from patients anticoagulated with direct oral anticoagulants or low molecular weight heparin (LMWH).
Objective
To compare fibrinogen results obtained with the Clauss (FIB C) method and the FIBPT‐d method with two thromboplastins in anticoagulated patients.
Population
The study population comprised 295 consecutive anticoagulated patients: 99 treated with vitamin K antagonists (VKAs), 49 treated with unfractionated heparin (UFH), 47 treated with LMWH, 50 treated with rivaroxaban, 50 treated with dabigatran, and 100 normal controls (NCs).
Methods
Dabigatran samples were analyzed by the use of FIB C with HemosIL Fibrinogen C or 100 NHI thrombin units mL reagents; rabbit brain and human recombinant thromboplastins with HemosIL PTFibrinogen HS plus (HS) and Recombiplastin 2G (RP) were used for FIBPT‐d method. Heparin and rivaroxaban levels were assessed with HemosIL Liq antiXa with specific calibrators; dabigatran levels were determined with the HemosIL Direct Thrombin Inhibitor Assay. All assays were performed on the ACL TOP platform in two laboratories. Percentage biases for the FIBPT‐d method versus the FIB C method were calculated by the use of Bland–Altman plots.
Results
Positive biases of the FIBPT‐d method versus the FIB C method with both thromboplastins were seen in NC samples (13.7% and 18.9% for HS and RP, respectively), but biases with HS in rivaroxaban and VKA patient samples were higher than that in NC samples, at 31.9% and 34.0%, respectively. LMWH patient samples showed higher bias than NC samples: 26.5% and 29.3.0% with HS and RP, respectively. UFH and dabigatran patient samples showed similar bias as NC samples.
Conclusion
The FIBPT‐d method should not be used in anticoagulated patients, because the FIBPT‐d mathematical algorithm has been validated only in normal subjects, so overestimation could occur in these patients.
Keyword(s)
blood coagulation tests, dabigatran, fibrinogen analysis, heparin, low molecular weight, rivaroxaban
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