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Use of the activated partial thromboplastin time for monitoring heparin therapy: Problems and possible solutions

Research in Clinic and Laboratory volume 19, pages 363–370 (1989)Cite this article

Summary

There is considerable variation in available methods for the activated partial thromboplastin time (APTT), giving widely differing results with patients on heparin treatment. The study is primarily concerned with the assessment of five of the widest used APTT reagents. The heparin response of these reagents has been related to their lipid composition and physical properties. Of the various correlations between lipid composition of the reagents and clotting performance only electrophoretic mobility was associated with the APTT response to heparin. There was a highly significant negative correlation between the APTT prolongation with heparin and electrophoretic mobility. When plasma is heparinizedin vitro a differing order of ranking for APTT reagents is obtained than when heparinized patients are tested. The APTT response in patients with recent thrombosis must therefore be the best guide to the clinical dose of heparin. The therapeutic range of conventional heparin therapy is generally regarded as 1.5–2.5 times the control. External quality assessment programmes in the UK and USA have shown considerable differences between heparin dosage according to the APTT test systems. The definition of the therapeutic range must be derived from randomized clinical studies. The need for progress in standardization of the APTT monitoring of heparin is demonstrated.

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Affiliations

  1. National (UK) Reference Laboratory for Anticoagulant Reagents and Control, Withington Hospital, M20 8LR, Manchester, Great Britain

    Leon Poller, Jean M. Thomson & David A. Taberner

Authors
  1. Leon Poller
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  2. Jean M. Thomson
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  3. David A. Taberner
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Poller, L., Thomson, J.M. & Taberner, D.A. Use of the activated partial thromboplastin time for monitoring heparin therapy: Problems and possible solutions. Res. Clin. Lab. 19, 363–370 (1989). https://doi.org/10.1007/BF02871827

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  • DOI: https://doi.org/10.1007/BF02871827

Key-words

  • Activated partial thromboplastin time
  • Electron microscopy
  • Electrophoresis
  • Heparin therapy
  • Phospholipids
  • Thrombosis