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Camilleri E, Maggini N, Piccica M, Botta A, Poli D. A rare case of prothrombin time prolongation. Intern Emerg Med 2021; 16:237-239. [PMID: 32557092 DOI: 10.1007/s11739-020-02408-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Eleonora Camilleri
- Center for Atherothrombotic Disease, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Niccolò Maggini
- Center for Atherothrombotic Disease, Careggi University Hospital, Florence, Italy
| | - Matteo Piccica
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniela Poli
- Center for Atherothrombotic Disease, Careggi University Hospital, Florence, Italy.
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Smith SE, Rumbaugh KA. False prolongation of International Normalized Ratio associated with daptomycin. Am J Health Syst Pharm 2018; 75:269-274. [DOI: 10.2146/ajhp170098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Susan E. Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia, Athens, GA
| | - Kelli A. Rumbaugh
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
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Saito M, Hatakeyama S, Hashimoto H, Suzuki T, Jubishi D, Kaneko M, Kume Y, Yamamoto T, Suzuki H, Yotsuyanagi H. Dose-dependent artificial prolongation of prothrombin time by interaction between daptomycin and test reagents in patients receiving warfarin: a prospective in vivo clinical study. Ann Clin Microbiol Antimicrob 2017; 16:27. [PMID: 28399872 PMCID: PMC5387382 DOI: 10.1186/s12941-017-0203-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 04/05/2017] [Indexed: 11/20/2022] Open
Abstract
Background Daptomycin has been reported to cause artificial prolongation of prothrombin time (PT) by interacting with some test reagents of PT. This prolongation was particularly prominent with high concentrations of daptomycin in vitro. However, whether this prolongation is important in clinical settings and the optimal timing to assess PT remain unclear. Methods A prospective clinical study was conducted with patients who received daptomycin for confirmed or suspected drug-resistant, gram-positive bacterial infection at a university hospital in Japan. PT at the peak and trough of daptomycin was tested using nine PT reagents. Linear regression analyses were used to examine the difference in daptomycin concentration and the relative change of PT-international normalized ratios (PT-INR). Results Thirty-five patients received daptomycin (6 mg/kg). The mean ± standard deviation of the trough and peak concentrations of daptomycin were 13.5 ± 6.3 and 55.1 ± 16.9 μg/mL, respectively. Twelve patients (34%) received warfarin. With five PT reagents, a significant proportion of participants experienced prolongation of PT-INR at the daptomycin peak concentration compared to the PT-INR at the trough, although the mean relative change was less than 10%. None of the participants clinically showed any signs of bleeding. A linear, dose-dependent prolongation of PT was observed for one reagent [unadjusted coefficient β 3.1 × 10−3/μg/mL; 95% confidence interval (CI) 2.3 × 10−5–6.3 × 10−3; p = 0.048]. When patients were stratified based on warfarin use, this significant linear relationship was observed in warfarin users for two PT reagents (adjusted coefficient β, 6.4 × 10−3/μg/mL; 95% CI 3.5 × 10−3–9.3 × 10−3; p < 0.001; and adjusted coefficient β, 8.3 × 10−3/μg/mL; 95% CI 4.4 × 10−3–1.2 × 10−2; p < 0.001). In non-warfarin users, this linear relationship was not observed for any PT reagents. Conclusions We found that a higher concentration of daptomycin could lead to artificial prolongation of PT-INR by interacting with some PT reagents. This change may not be clinically negligible, especially in warfarin users receiving a high dose of daptomycin. It may be better to measure PT at the trough rather than at the peak daptomycin concentration.
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Affiliation(s)
- Makoto Saito
- Department of Infectious Diseases, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shuji Hatakeyama
- Department of Infectious Diseases, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Division of General Internal Medicine, Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Hideki Hashimoto
- Department of Infectious Diseases, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takumitsu Suzuki
- Department of Infectious Diseases, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daisuke Jubishi
- Department of Infectious Diseases, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Makoto Kaneko
- Department of Clinical Laboratory, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukio Kume
- Department of Clinical Laboratory, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takehito Yamamoto
- Department of Pharmacy, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Suzuki
- Department of Pharmacy, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Yotsuyanagi
- Department of Infectious Diseases, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Effects of Oritavancin on Coagulation Tests in the Clinical Laboratory. Antimicrob Agents Chemother 2017; 61:AAC.01968-16. [PMID: 27956417 DOI: 10.1128/aac.01968-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/25/2016] [Indexed: 11/20/2022] Open
Abstract
Previous studies have shown that some lipoglycopeptide and lipopeptide antimicrobial agents may cause falsely elevated values for some phospholipid-dependent coagulation tests. The effect of oritavancin, a lipoglycopeptide antibiotic, on coagulation test results was explored using pooled human plasma samples spiked with drug and in a clinical study after an infusion of a single 1,200-mg intravenous dose of oritavancin in normal healthy volunteers. Pooled plasma with oritavancin added ex vivo showed concentration-dependent prolongation of prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), and dilute Russell viper venom time (DRVVT) test results. In contrast, oritavancin had no effect on the activated protein C resistance assay, chromogenic anti-factor Xa assay (anti-FXa), thrombin time, and an immunoassay for the laboratory diagnosis of heparin-induced thrombocytopenia. In participants that received a single dose of oritavancin, elevations in PT/INR result, aPTT, DRVVT, activated clotting time, and silica clotting time occurred, with the maximum times to resolution of test interference determined to be 12, 120, 72, 24, and 18 h, respectively. The anti-FXa assay was unaffected, whereas transient elevations in D dimer levels were observed in 30% of participants, with a maximum time to resolution of 72 h. Although oritavancin has no impact on the coagulation system in vivo, a single dose of oritavancin can produce falsely elevated values of some coagulation tests used to monitor hemostasis. The interference of oritavancin on affected tests is transient, and the test results revert to normal ranges within specified times after dosing.
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Yamada T, Kato R, Oda K, Tanaka H, Suzuki K, Ijiri Y, Ikemoto T, Nishihara M, Hayashi T, Tanaka K, Tamai H, Ukimura A, Katsumata T. False Prolongation of Prothrombin Time in the Presence of a High Blood Concentration of Daptomycin. Basic Clin Pharmacol Toxicol 2016; 119:353-9. [PMID: 27060578 DOI: 10.1111/bcpt.12597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/01/2016] [Indexed: 12/13/2022]
Abstract
Prothrombin time (PT) can reportedly be falsely prolonged by the antimicrobial drug daptomycin (DAP), and concomitant use of phosphatidylglycerol (PG). Although high doses of DAP (>6 mg/kg/day) are recommended for severe infection and result in a high blood concentration, the extent to which high blood concentrations of DAP interfere with PT, in the presence or absence of PG, has yet to be determined when using the HemosIL RecombiPlasTin 2G (Werfen Japan, Tokyo, Japan). We examined the effects of high doses of DAP on PT using this reagent. DAP (0-500 mg/L) was added to normal plasma and plasma with an already prolonged PT in the presence or absence of liposomal amphotericin B (L-AMB, 5-50 mg/L) or COATSOME EL-01 empty cationic liposomes (CS, 25-250 mg/L). Furthermore, we undertook a Monte Carlo simulation to calculate the probability of achieving DAP concentrations >100, >200 and >500 mg/L 0-48 hr after administering 6-12 mg/kg of DAP. Apparent PT increased with increasing DAP concentration, but neither L-AMB nor CS appeared to further elevate PT when co-administered with DAP. The probability of achieving DAP concentrations >100 and >200 mg/L increased with DAP dose. Higher doses of DAP than the approved dose caused false prolongation of PT. PT should be monitored carefully in patients taking high doses of DAP; ideally, PT should be measured at the trough blood concentration of DAP. Concomitant use of L-AMB and CS did not generally further elevate PT when co-administered with DAP.
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Affiliation(s)
- Tomoyuki Yamada
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan. .,Infection Control Center, Osaka Medical College Hospital, Takatsuki, Osaka, Japan.
| | - Ryuji Kato
- Laboratory of Cardiovascular Pharmacology and Toxicology, Osaka University of Pharmaceutical Sciences, Osaka, Japan
| | - Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
| | - Hidema Tanaka
- Department of Clinical Laboratory, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Kaoru Suzuki
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Yoshio Ijiri
- Laboratory of Cardiovascular Pharmacology and Toxicology, Osaka University of Pharmaceutical Sciences, Osaka, Japan
| | - Toshiyuki Ikemoto
- Department of Clinical Laboratory, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Masami Nishihara
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Tetsuya Hayashi
- Laboratory of Cardiovascular Pharmacology and Toxicology, Osaka University of Pharmaceutical Sciences, Osaka, Japan.,Department of Internal Medicine III, Osaka Medical College, Osaka, Japan
| | | | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Akira Ukimura
- Infection Control Center, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Takahiro Katsumata
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
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Hartmann B, Maus S, Keller F, Rothermund L. Thrombocytopenia, INR Prolongation and Fall in Fibrinogen Under Daptomycin. J Chemother 2013; 23:183-4. [DOI: 10.1179/joc.2011.23.3.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Tripodi A, Chantarangkul V, Legnani C, Fronton R, Testa S. Discrepancy of the international normalized ratio observed in the external quality assessment survey: a cause for concern. J Thromb Haemost 2012; 10:714-6. [PMID: 22934292 DOI: 10.1111/j.1538-7836.2012.04628.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Tripodi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine, Università degli Studi di Milano and IRCCS Cà Granda Ospedale Maggiore Foundation, Milan; Italy
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Barriere SL, Goldberg MR, Janc JW, Higgins DL, Macy PA, Adcock DM. Effects of telavancin on coagulation test results. Int J Clin Pract 2011; 65:784-9. [PMID: 21564449 DOI: 10.1111/j.1742-1241.2011.02668.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The lipoglycopeptide antibiotic, telavancin, may interfere with some laboratory coagulation tests including prothrombin time (PT) and activated partial thromboplastin time (aPTT). OBJECTIVE To evaluate the effects of telavancin on PT and aPTT assays in common use. METHODS Pooled normal human plasma was spiked with telavancin 10, 20, 100 or 200 μg/ml (equivalent to trough, 2 × trough, peak and 2 × peak clinical plasma concentrations, respectively) or diluent control (0.9% sodium chloride). Samples were analysed using 16 PT reagents and seven aPTT reagents. RESULTS Telavancin 200 μg/ml (corresponding to 2 × peak clinical plasma concentration), produced significant PT prolongation (> 9% difference vs. diluent control) with all the 16 PT reagents (range 12% to > 600%). At lower telavancin concentrations, PT prolongation was dose-dependent and varied among reagents, but appeared greatest with preparations containing recombinant tissue factor. With telavancin 10 μg/ml (equivalent to trough), PT prolongation was 10% with HemosIL(®) PT-Fibrinogen Recombinant, while ranging from 5% to -1% with all other reagents. Significant (> 34% difference vs. baseline) and dose-dependent aPTT prolongation was observed with all the seven reagents in samples spiked with telavancin 100 or 200 μg/ml (range 65-142% at 200 μg/ml). aPTT reagents containing a silica activator appeared to be more sensitive to telavancin interference. Telavancin 10 μg/ml was not associated with increased aPTT with any of the reagents tested. CONCLUSIONS Telavancin has the potential to prolong both PT and aPTT in vitro. It is recommended that samples for PT or aPTT be obtained just prior to a telavancin dose (trough).
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Affiliation(s)
- S L Barriere
- Theravance, Inc., South San Francisco, CA 94080, USA.
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van den Besselaar AMHP, Breukink E, Koorengevel MC. Phosphatidylglycerol and daptomycin synergistically inhibit tissue factor-induced coagulation in the prothrombin time test. J Thromb Haemost 2010; 8:1429-30. [PMID: 20345716 DOI: 10.1111/j.1538-7836.2010.03868.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van den Besselaar A, Chantarangkul V, Tripodi A. Effect of prothrombin time outlier exclusion rules on ISI calibration in multicentre studies. Thromb Res 2010; 125:523-8. [DOI: 10.1016/j.thromres.2010.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 12/11/2009] [Accepted: 01/11/2010] [Indexed: 01/21/2023]
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van den Besselaar AMHP, Chantarangkul V, Tripodi A. Thromboplastin standards. Biologicals 2010; 38:430-6. [PMID: 20338779 DOI: 10.1016/j.biologicals.2010.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 02/11/2010] [Indexed: 12/26/2022] Open
Abstract
The Prothrombin Time (PT) test is used for monitoring of treatment with Vitamin K-antagonists (VKA). The result of the PT test should be expressed as the International Normalized Ratio (INR). Calculation of INR is based on the availability of International Standards (IS) for thromboplastin and a calibration model. Calibration of a new PT test system is performed with the appropriate IS and fresh plasma samples of healthy (normal) volunteers and patients treated with VKA. The calibration model is based on the assumption of a linear relationship between the log(PT)'s obtained with the new PT system and the reference IS for both normal and patients' samples. Patients' samples for calibration should be selected by rejecting samples beyond the 1.5-4.5 INR range. Outliers should be rejected defined as points with a perpendicular distance greater than three residual standard deviations from the line of relationship. Selection of patients' samples and rejection of outliers result in a reduction of the between-laboratory variation of calibration. In addition to monitoring of VKA, the PT is used for management of patients with chronic liver disease. Likewise, INR(liver) should be based on calibration with an IS using samples from patients with chronic liver disease.
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Attermann J. An International Normalized Ratio (INR) calibration model that is too simple leads to bias and overestimated accuracy of INR values: a rebuttal. J Thromb Haemost 2007; 5:2159-60; authors reply 2161. [PMID: 17650081 DOI: 10.1111/j.1538-7836.2007.02692.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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VAN DEN BESSELAAR AMHP, TRIPODI A. An International Normalized Ratio (INR) calibration model that is too simple leads to bias and overestimated accuracy of INR values: reply to a rebuttal. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.02693.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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