What anticoagulant therapy is monitored using the ecarin clotting ...

[leilurhhh]

What anticoagulant therapy is monitored using the ecarin clotting time (ECT)?
 
  a. Unfractionated heparin
  b. Warfarin
  c. LMWH
  d. Direct thrombin inhibitors

Question 2

After confirmation of a deep vein thrombosis (DVT) and pulmonary embolus in a patient, a baseline coagulation screen and platelet count are obtained.
 
  His fibrinogen is 620 mg/dL. When the PTT is performed at 6 hours after initiation of therapy, it is 45 seconds (reference range, 25 to 37 seconds). What should be done?
 
  a. Report the PTT as not responding.
  b. Monitor the patient with the chromogenic anti-Xa assay.
  c. Add an additional standard amount of heparin to the patient plasma to improve the sensitivity.
  d. Add a standard amount of antithrombin to the patient plasma to improve the sensitivity.

[mohan]

Answer to Question 1

ANS: D
The ECT uses an enzyme extracted from Echis carinatus venom. Direct thrombin inhibitors yield a linear, dose-dependent response to the ECT. The test is useful for monitoring direct thrombin inhibitors when the patient has lupus anticoagulant or factor deficiencies.

Answer to Question 2

ANS: B
An elevated fibrinogen tends to shorten the PTT and makes it less sensitive to the effect of heparin; this is called heparin resistance. The chromogenic anti-Xa assay should then be used to monitor this patient.

[leilurhhh]

TYSM

[carlsona147]

Excellent