Near-site monitoring of the antiplatelet drug abciximab using the hemodyne analyzer and modified thrombelastograph^,

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• 作者：Philip E. Greilich ; Barbara M. Alving ; David Longnecker ; Marcus E. Carr Jr ; Charles W. Whitten ; Audrey S. Chang ; Thomas J. Reid
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：1999
• 出版时间：February 1999
• 年：1999
• 卷：13
• 期：1
• 页码：58-64
• 全文大小：842 K

文摘

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).

In vitro dose-response and reversal study.

Anesthesia Research (Dallas, TX) and Special Studies Coagulation Laboratories (Washington, DC).

Nine healthy volunteers.

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 % .

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 MA_WB 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.

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.