TY - JOUR
T1 - Near-site monitoring of the antiplatelet drug abciximab using the hemodyne analyzer and modified thrombelastograph
AU - Greilich, Philip E.
AU - Alving, Barbara M.
AU - Longnecker, David
AU - Carr, Marcus E.
AU - Whitten, Charles W.
AU - Chang, Audrey S.
AU - Reid, Thomas J.
N1 - Funding Information:
From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center-Dallas; Anesthesia Research Laboratory, Dallas Veterans Affairs Medical Center, Dallas, TX; Departments of Hematology and Vascular Biology and Clinical Investigation, Walter ReedArmy Institute of Research, Washington, DC; and the Departments of Internal Medicine and Pathology, Medical College of Virginia~Virginia Commonwealth University, Richmond, VA. Supported in part by the Combat Casualty Care Program of the Medical Research Material Command of the United States Army, Ft Dietrach, MD. The opinions expressed herein are the private views of the authors and are not to be construed as official or reflecting the views of the Departments of the Army or Defense. Address reprint requests to Philip E. Greilich, MD, Anesthesiology and Pain Management Service (l12A); Department of Veteran's Affairs Medical Center--Dallas, 4500 South Lancaster Rd, Dallas, TX 75216. Copyright © 1999 by W.B. Saunders Company 1053-0770/99/1301-0013510.00/0
PY - 1999/2
Y1 - 1999/2
N2 - Objective: This investigation examines the hypothesis that the antiplatelet effect of abciximab and its reversal can be monitored using the Hemodyne (Hemodyne, Inc, Midlothian, VA) analyzer and modified Thrombelastograph (Haemoscope, Skokie, IL). Design: In vitro dose-response and reversal study. Setting: Anesthesia Research (Dallas, TX) and Special Studies Coagulation Laboratories (Washington, DC). Participants: Nine healthy volunteers. Interventions: The addition of increasing concentrations of abciximab, 0 to 10 μg/mL, and purified fibrinogen, 50 to 400 mg/dL. The reversal of abciximab, 4 μg/mL, with the addition of fresh platelet-rich plasma (PRP) sufficient to increase the platelet concentration by approximately 10%. Measurements and Main Results: Platelet aggregation and platelet contractile force using the Hemodyne analyzer were used as platelet- specific measurements. The Thrombelastograph maximum amplitude (MA) for platelets (MA(PLT)) was calculated by subtracting the MA from a platelet- poor plasma (PPP) sample (MA(ppp)) determined in one thromboelastography well from that of whole-blood MA (MA(WB)) run simultaneously in the second thromboelastography well. The addition of abciximab, 0 to 10 μg/mL, resulted in significant concentration-dependent reductions in platelet aggregation (p < 0.001), platelet contractile force (p < 0.001), and MA(PLT) (p < 0.001). Platelet contractile force (p < 0.03) and MA(PLT) (p < 0.05) were significantly more responsive than MAws to the effect of abciximab, 4 μg/mL, and its reversal with the addition of fresh PRP. Purified fibrinogen concentration directly correlated with thromboelastography MA (r(s) = 0.97; p < 0.001), yet had no effect on platelet contractile force. The addition of abciximab had no measurable influence on the MA(ppp). Conclusion: This in vitro study suggests that the Hemodyne analyzer and modified Thrombelastograph might be clinically useful methods to monitor the platelet inhibitory effects of agents such as abciximab.
AB - Objective: This investigation examines the hypothesis that the antiplatelet effect of abciximab and its reversal can be monitored using the Hemodyne (Hemodyne, Inc, Midlothian, VA) analyzer and modified Thrombelastograph (Haemoscope, Skokie, IL). Design: In vitro dose-response and reversal study. Setting: Anesthesia Research (Dallas, TX) and Special Studies Coagulation Laboratories (Washington, DC). Participants: Nine healthy volunteers. Interventions: The addition of increasing concentrations of abciximab, 0 to 10 μg/mL, and purified fibrinogen, 50 to 400 mg/dL. The reversal of abciximab, 4 μg/mL, with the addition of fresh platelet-rich plasma (PRP) sufficient to increase the platelet concentration by approximately 10%. Measurements and Main Results: Platelet aggregation and platelet contractile force using the Hemodyne analyzer were used as platelet- specific measurements. The Thrombelastograph maximum amplitude (MA) for platelets (MA(PLT)) was calculated by subtracting the MA from a platelet- poor plasma (PPP) sample (MA(ppp)) determined in one thromboelastography well from that of whole-blood MA (MA(WB)) run simultaneously in the second thromboelastography well. The addition of abciximab, 0 to 10 μg/mL, resulted in significant concentration-dependent reductions in platelet aggregation (p < 0.001), platelet contractile force (p < 0.001), and MA(PLT) (p < 0.001). Platelet contractile force (p < 0.03) and MA(PLT) (p < 0.05) were significantly more responsive than MAws to the effect of abciximab, 4 μg/mL, and its reversal with the addition of fresh PRP. Purified fibrinogen concentration directly correlated with thromboelastography MA (r(s) = 0.97; p < 0.001), yet had no effect on platelet contractile force. The addition of abciximab had no measurable influence on the MA(ppp). Conclusion: This in vitro study suggests that the Hemodyne analyzer and modified Thrombelastograph might be clinically useful methods to monitor the platelet inhibitory effects of agents such as abciximab.
KW - Abciximab
KW - Blood
KW - Hemodyne
KW - Platelet aggregation
KW - Platelet contractile force
KW - Platelet function
KW - Platelet function monitoring
KW - Platelet inhibition
KW - Platelets
KW - Shear elasticity
KW - Thrombelastograph
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U2 - 10.1016/S1053-0770(99)90175-1
DO - 10.1016/S1053-0770(99)90175-1
M3 - Article
C2 - 10069286
AN - SCOPUS:0033016875
SN - 1053-0770
VL - 13
SP - 58
EP - 64
JO - Journal of cardiothoracic and vascular anesthesia
JF - Journal of cardiothoracic and vascular anesthesia
IS - 1
ER -