AJHE2302 - CME/CMLE - Monitoring Direct Thrombin Inhibitors with Calibrated Diluted Thrombin Time versus Activated Partial Thromboplastin Time in Pediatric Patients-Monitoring Direct Thrombin Inhibitors with Calibrated Diluted Thrombin Time versus Activated Partial Thromboplastin Time in Pediatric Patients

Monitoring Direct Thrombin Inhibitors with Calibrated Diluted Thrombin Time versus Activated Partial Thromboplastin Time in Pediatric Patients

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The study discussed in the document compares the monitoring of direct thrombin inhibitors (DTIs) in pediatric patients using the diluted thrombin time (dTT) assay versus the activated partial thromboplastin time (aPTT). The research found that the dTT assay was more likely to show a stable dose-response and have a stronger correlation with DTI dose than the aPTT assay. Specifically, the dTT had a fivefold increased likelihood of significant correlation with DTI concentrations compared to aPTT. The study included pediatric patients receiving argatroban and bivalirudin, showing that the dTT was more reliable in monitoring DTI levels accurately. The research also found that bivalirudin exhibited less variability in dose response compared to argatroban, which showed more inter- and intrapatient variation. The study focused on developing an adaptable calibrated dTT assay for monitoring DTIs, emphasizing the importance of accurate monitoring for effective anticoagulation therapy. The document highlights the potential of dTT as a more accurate and accessible method for monitoring DTIs in clinical practice, ultimately suggesting the dTT as the standard assay for measuring DTI levels. Further research is recommended to establish optimal therapeutic target ranges for DTIs to improve outcomes in both pediatric and adult populations using this method.

Keywords

direct thrombin inhibitors

DTIs

dTT assay

activated partial thromboplastin time

aPTT assay

pediatric patients

argatroban

bivalirudin

anticoagulation therapy

therapeutic target ranges