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Comparison of the native prothrombin antigen and the prothrombin time for
monitoring oral anticoagulant therapy
B Furie, HA Liebman, RA Blanchard, MS Coleman, SF Kruger and BC Furie
We have measured the fully carboxylated (native) prothrombin antigen and
the undercarboxylated (abnormal) prothrombin antigen in patients treated
with sodium warfarin using specific immunoassays to evaluate a new approach
for monitoring oral anticoagulant therapy. Plasma and serum samples (391)
were assayed for the prothrombin time, native prothrombin antigen, and
abnormal prothrombin antigen. The results were correlated with the presence
of bleeding or thromboembolic complications at the time of phlebotomy. The
native prothrombin antigen correlated with the occurrence of complications
in 95% of samples. Of 13 samples from patients with bleeding complications,
13/13 (100%) had a native prothrombin of 12 micrograms/mL or lower. Of
seven samples from patients with thromboembolic complications, 6/7 (86%)
had a native prothrombin of 24 micrograms/mL or greater. By comparison, a
prothrombin time index of 1.5 to 2.5, 1.5 to 2.2, 1.5 to 2.0, or 1.3 to 1.8
identified 6/20 (30%), 9/20 (45%), 11/20 (55%), or 12/20 (60%) patients at
risk, respectively. Although the prothrombin time index did correlate with
the presence of bleeding complications, the native prothrombin antigen
correlated closely with the presence of bleeding and thromboembolic
complications. According to these results, the native prothrombin antigen,
maintained in a range of 12 to 24 micrograms/mL by regular adjustment of
the warfarin dosage, may be associated with a reduced risk of complications
due to excessive or insufficient warfarin therapy. On the basis of these
preliminary data, we recommend that the native prothrombin antigen be
considered to monitor warfarin therapy.
Volume 64,
Issue 2,
pp. 445-451,
08/01/1984
Copyright © 1984 by The American Society of Hematology
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