Point-of-care ecarin clotting time versus activated clotting time in correlation with bivalirudin concentration

Ivan P. Casserly, Dean J. Kereiakes, William A. Gray, Paul H. Gibson, Michael A. Lauer, Joel P. Reginelli, David J. Moliterno

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Introduction: A thrombin inhibitor management (TIM) point-of-care test based upon the ecarin clotting time (ECT) has been developed. The ECT has been suggested to more accurately reflect the anti-coagulant effect of direct thrombin inhibitors compared with the activated clotting time (ACT). We sought to examine the correlation of the TIM-ECT test with bivalirudin concentration in patients undergoing percutaneous coronary intervention (PCI), and to compare the performance of this test with the current standard (i.e., ACT). Materials and methods: In a multicenter study, blood samples were obtained at six pre-defined time-points in 170 consecutive patients undergoing PCI using bivalirudin. For each sample, the TIM-ECT (citrated and non-citrated), ACT, and bivalirudin concentration was determined. Results: Considering samples from all time-points (n=784), the correlations of TIM-ECT citrated, TIM-ECT non-citrated, and ACT with bivalirudin concentration were 0.96, 0.93, and 0.90, respectively. For samples collected at therapeutic levels of bivalirudin (n=353), the correlations of TIM-ECT citrated, TIM-ECT non-citrated, and ACT with bivalirudin concentration were lower, and showed a greater disparity between methods, with correlation coefficients of 0.75, 0.59, and 0.37, respectively. Prediction models based on the measured bivalirudin concentration were developed for TIM-ECT and ACT, and the coefficients of determination (r2) of actual versus predicted TIM-ECT and ACT were 0.91 and 0.81, respectively. Conclusions: In this PCI population, the TIM-ECT point-of-care test and ACT demonstrated a strong correlation with bivalirudin concentration. The TIM-ECT test had a higher correlation with bivalirudin concentration at therapeutic levels of the drug, and for individual samples appears to more consistently reflect the bivalirudin concentration compared with the ACT.

Original languageEnglish
Pages (from-to)115-121
Number of pages7
JournalThrombosis Research
Volume113
Issue number2
DOIs
StatePublished - 2004

Keywords

  • ACT
  • Activated clotting time
  • activated clotting time
  • Bivalirudin
  • Direct thrombin inhibitor
  • Ecarin clotting time
  • ecarin clotting time
  • ECT
  • glycoprotein
  • GP
  • PCI
  • Percutaneous coronary intervention
  • percutaneous coronary intervention
  • TIM

ASJC Scopus subject areas

  • Hematology

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