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Thromb Haemost 1970; 17(03): 569-584
DOI: 10.1055/s-0038-1654188
Originalarbeiten – Original Articles – Travaux Originaux
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Laboratory Control of Oral Anticoagulants

Definition of Therapeutic Range in Terms of Different Thromboplastin Preparations
E. A Loeliger
1   Haematology Section of the Department of Medicine, Leiden University Hospita and the Leiden Thrombosis Service
,
J. B Meuwisse-Braun
1   Haematology Section of the Department of Medicine, Leiden University Hospita and the Leiden Thrombosis Service
,
H Muis
1   Haematology Section of the Department of Medicine, Leiden University Hospita and the Leiden Thrombosis Service
,
F. J. J Buitendijk
1   Haematology Section of the Department of Medicine, Leiden University Hospita and the Leiden Thrombosis Service
,
J. J Veltkamp
1   Haematology Section of the Department of Medicine, Leiden University Hospita and the Leiden Thrombosis Service
,
H. C Hemker
1   Haematology Section of the Department of Medicine, Leiden University Hospita and the Leiden Thrombosis Service
› Author Affiliations
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Publication History

Publication Date:
27 June 2018 (online)

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Summary

The therapeutic range in oral anticoagulation, which is defined as the range of hypocoagulability resulting in optimal thrombosis prophylaxis and an acceptable bleeding tendency, is monitored by assay procedures of which the majority are modifications of Quick’s original prothrombin time test. With respect to individual patients on stabilized anticoagulation, the different modifications commonly used give the same information, the reliability depending more on the accuracy than on the sensitivity of the tests. The results do not appear to be comparable in terms of conventional reference curves or prolongation ratios of the coagulation times found, but on the basis of painstakingly defined normal and patient plasma, the mean of the factor II and factor X activity present in patients’ plasma proved to be a useful common denominator. In terms of this common denominator, the therapeutic range to be aimed at lies between (8 to) 10 and 20(to 25)percent.

 

  • References

  • 1 Quick A. J, Stanley-Brown M, Bancroft F. W. A study of the coagulation defect in hemophilia and in jaundice. Amer. J. med. Sci 190: 501-511 1935;
    CrossrefPubMedGoogle Scholar
  • 2 Owren B. A. The P & P method. Scand. J. clin. Lab. Invest 3: 201-204 1951;
    CrossrefPubMedGoogle Scholar
  • 3 Owren P. A. “Thrombotest”: A new method for controlling anticoagulant therapy. Lancet 71: 754-758 1959;
    PubMedGoogle Scholar
  • 4 Hemker H. C, Veltkamp J. J, Loeliger E. A. Kinetic aspects of the interaction of blood clotting enzymes. III. Demonstration of an inhibitor of prothrombin conversion in vitamin K deficiency. Thrombos. Diathes. haemorrh. (Stuttg.) 19: 347-363 1968;
    PubMedGoogle Scholar
  • 5 Miale J. B, Lafond D. J. 1963 Prothrombin time test survey, College of American Pathologists, Standard Committee, Subcommittee on Coagulation. Amer. J. clin. Path 47: 40-59 1967;
    PubMedGoogle Scholar
  • 6 Bowerman D, Notestine H. Quality control in coagulation studies. An evaluation of control systems for plasma prothrombin determinations. Amer. J. clin. Path 39: 535-537 1969;
    PubMedGoogle Scholar
  • 7 van Horn P. Quality control of prothrombin determinations. Normal and abnormal prothrombin activity levels. Amer. J. med. Technol 34: 1-8 1968;
    PubMedGoogle Scholar
  • 8 Biggs R, Denson K. W. E. Standardization of the one-stage prothrombin time for the control of anticoagulant therapy. Brit. Med. J 1: 84-88 1967;
    CrossrefPubMedGoogle Scholar
  • 9 Loeliger E. A, Taconis W. K, Veltkamp J. J, Hemker H. G. Standardization of results obtained with different thromboplastin preparations. Conf. Int. Comm. Haemostasis Thrombosis, Princeton (1968).
    PubMedGoogle Scholar
  • 10 Koller F, Loeliger E. A, Duckert F. Experiments on a new clotting factor. (Factor VII). Acta haemat. (Basel) 6: 1-18 1951;
    CrossrefPubMedGoogle Scholar
  • 11 Owren P. A. A quantitative one-stage method for the assay of prothrombin. Scand. J. clin. Lab. Invest 1: 81-83 1949;
    CrossrefPubMedGoogle Scholar
  • 12 Hemker H. G, Hemker P. W, Loeliger E. A. Kinetic aspects of the interaction of blood clotting enzymes. I. Derivation of basic formulas. Thrombos. Diathes. haemorrh. (Stuttg.) 13: 155-175 1965;
    PubMedGoogle Scholar
  • 13 Borchgrevink G. F, Pool J. G, Stormorken H. A new assay for factor V (proaccelerin-accelerin) using Russell’s viper venom. J. Lab. clin. Med 55: 625-632 1960;
    PubMedGoogle Scholar
  • 14 Lechner K, Deutsch E, Reimitzer I. Eine einfache Methode zur Herstellung von menschlichem Faktor-VII-Mangelplasma. Thrombos. Diathes. haemorrh. (Stuttg.) 18: 252-258 1967;
    PubMedGoogle Scholar
  • 15 Loeliger E. A. Schlechte Eigenschaft langwirkender Cumarine oder für deren Kontrolle ungeeignete Thrombokinase ? Schweiz, med. Wschr 88: 639-643 1958;
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 de Vries S. I, Abels J, Haanen C. A. M, Loeliger E. A. De Thrombo-test van Owren. Ned. T. Geneesk 105: 977-980 1961;
    PubMedGoogle Scholar
  • 17 Poller L. Methods for the laboratory control of short-term anticoagulant therapy. Acta haemat. (Basel) 28: 168-179 1962;
    CrossrefPubMedGoogle Scholar
  • 18 Loeliger E. A, Hensen A, Kroes F, van Dijk L. M, Fekkes N, Hemker H. C. A double-blind trial on long-term anticoagulant treatment after myocardial infarction. Acta med. scand 182: 549-566 1967;
    PubMedGoogle Scholar
  • 19 Meuwissen O. J. A. Th, Vervoorn A. G, Cohen O, Jordan F. L. J. Interim report on the Utrecht Study of long-term anticoagulant therapy in occlusive coronary artery disease. Acta med. scand 186: 361-365 1969;
    PubMedGoogle Scholar
  • 20 Roos J, van Joost H. E. The cause of bleeding during anticoagulant treatment. Acta med. scand 178: 129-131 1965;
    PubMedGoogle Scholar
  • 21 Rozenberg M. G, Kronenberg H, Firkin B. G. “Thrombotest” and Prothrombin time: A controlled clinical trial. Aust. Ann. Med 14: 3-12 1965;
    PubMedGoogle Scholar
  • 22 Sevitt S, Innes D. Prothrombin-time and Thrombotest in injured patients on prophylactic anticoagulant therapy. Lancet I: 124-129 1964;
    PubMedGoogle Scholar
  • 23 Kuijer P. J, Leeksma G. H. W. Profylaxe van veneuze thromboembolische complicaties met behulp van anticoagulantia. Ned. T. Geneesk 109: 1480-1484 1965;
    PubMedGoogle Scholar
  • 24 Report of the Working Party on Anticoagulant Treatment in Coronary Thrombosis to the Medical Research Council: Assessment of short-term anticoagulant administration after cardiac infarction. Brit. med. J 1: 335-342 1969;
    CrossrefPubMedGoogle Scholar
  • 25 Rabiner S. F. The relationship of coagulation defects to haemorrhage in patients receiving oral anticoagulants. Amer. J. med. Sci 249: 68-75 1965;
    PubMedGoogle Scholar
  • 26 Beaumont P. M. Jaarverslag van de Thrombosedienst van het Nederlandsche Roode Kruis (1963).
    PubMedGoogle Scholar
  • 27 Loeliger E. A, Hemker H. G. Principles of the mode of action of coumarin congeners. Proc. 3rd Int. Pharmacol Meeting Sao Paolo. Pergamon Press, Oxford & New York 6: 13-24 1968;
    PubMedGoogle Scholar
  • 28 van der Esch B, Loeliger E. A. De werking van coumarinepreparaten op de bloedstolling bij hoge initiële dosering. Verslag 3e Conf. Thrombosediensten Nederlandsche Roode Kruis, Zeist.p.26 (1960).
    PubMedGoogle Scholar
  • 29 Loeliger E. A, B. v. d. Esch M, Mattern J, den Brabander A. S. A. Behaviour of factor II, VII, IX, and X during long-term treatment with coumarin. Thrombos. Diathes. haemorrh. (Stuttg.) 9: 75-89 1963;
    PubMedGoogle Scholar
  • 30 Loeliger E. A, Hensen A, Mattern M. J, Hemker H. G. Behaviour of factors II, VII, IX, and X in bleeding complications during long-term treatment with coumarin. Thrombos. Diathes. haemorrh. (Stuttg.) 10: 278-281 1964;
    PubMedGoogle Scholar
  • 31 Hemker H. G, Veltkamp J. J, Hensen A, Loeliger E. A. Nature of prothrombin biosynthesis: preprothrombinaemia in vitamin K-deficiency. Nature (Lond.) 200: 589-591 1963;
    CrossrefPubMedGoogle Scholar
  • 32 Hemker H. G, Annemarie Muller E, Loeliger A. Two types of prothrombin in vitamin K deficiency. Thrombos. Diathes. haemorrh. (Stuttg.) 23: 652 1970;
    PubMedGoogle Scholar
  • 33 Hart H. Ch, Loeliger E. A. Een onderzoek naar de overerving van prothrombinedeficientie. Ned. T. Geneesk 107: 1107-1108 1963;
    PubMedGoogle Scholar
  • 34 Meer J. van der, Hemker H. G, Loeliger E. A. Pharmacological aspects of vitamin K1 . A clinical and experimental study in man. Thrombos. Diathes. haemorrh. (Stuttg.) Suppl. 29 (1968).
    PubMedGoogle Scholar
  • 35 Schrogie J. J, Solomon H. M, Zieve P. D. Effect of oral contraceptives on vitamin Independent clotting activity. Clin, pharmacol. Ther 8: 670-675 1967;
    CrossrefPubMedGoogle Scholar
  • 36 Murphy E. A. Proc. Conf. Int. Comm. Haemostasis and Thrombosis. Washington 1967.
    PubMedGoogle Scholar
  • 37 Loeliger E. A, Hemker H. G. Considerations on an international standard for the one-stage prothrombin time in the control of anticoagulant therapy. Conf. Int. Comm. Haemostasis Thrombosis. Washington 1967.
    PubMedGoogle Scholar