Hirudin versus citrate as an anticoagulant for ROTEM
Research article published in Platelets (2023)
Abstract
Citrate is widely used as an anticoagulant for platelet function tests (PFTs). Due to an intrinsic inhibitory effect of citrate on platelet function, hirudin is used as an alternative. However, studies comparing the effect of these anticoagulants on rotational thromboelastometry (ROTEM) platelet whole blood impedance aggregometry in thrombocytopenic patients are scant. Cross-sectional study was done in 105 patients who entered the critical phase of Dengue hemorrhagic fever with plasma leakage and severe thrombocytopenia (<100 × 109/L). Samples were collected on two consecutive days and considered as a combined data set for analysis, out of which 200 have been included in the data analysis. Platelet count was used from routine full blood count. ROTEM platelet used TRAPTEM assay, which was performed with 3.2% sodium citrate and 525 ATU/ml hirudin anticoagulated blood. Means of all the TRAPTEM parameters were significantly higher in hirudin, compared to citrate samples (p < .05). Significantly higher overall platelet aggregation was observed in hirudinized samples with a significant mean difference (p < .05) compared to citrate in each quartile of platelet count. Higher platelet aggregation was observed with hirudin compared to citrate in ROTEM platelet whole blood impedance aggregometry in thrombocytopenic patients elaborating the importance of using hirudin anticoagulation in PFTs, particularly in patients with severe thrombocytopenia. Citrate is the most commonly used anticoagulant for coagulation studies including rotational thromboelastometry (ROTEM).Hirudin is an alternative option to be used as an anticoagulant for PFTs because of the inhibitory effect of citrate on platelet function.One study (Nissen et al. (2020)) reported higher precision and platelet aggregation with hirudinized blood of healthy individuals, over citrate using ROTEM platelet.However, none of the studies were performed in patients in actual clinical context.We evaluated the potential benefit of using hirudin anticoagulated blood over citrate in thrombocytopenic patients due to Dengue hemorrhagic fever using ROTEM platelet.We observed higher platelet aggregation with hirudin compared to citrate suggesting the importance of using hirudin anticoagulation in PFTs, particularly in patients with severe thrombocytopenia.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Citrate is widely used as an anticoagulant for platelet function tests (PFTs). Due to an intrinsic inhibitory effect of citrate on platelet function, hirudin is used as an alternative.
Por qué esto importa para la hirudoterapia
Este estudio transversal comparó hirudin frente a citrato como anticoagulantes para la agregometría de impedancia de sangre total plaquetaria con ROTEM en 105 pacientes con fiebre hemorrágica del dengue trombocitopénica. Todos los parámetros de TRAPTEM y la agregación plaquetaria global fueron significativamente más altos en las muestras anticoaguladas con hirudin en comparación con citrato a lo largo de cada cuartil de recuento plaquetario (p < .05), lo que sugiere la ventaja del hirudin para las pruebas de función plaquetaria, particularmente en trombocitopenia grave. Para el ámbito de ASH, el estudio es relevante únicamente en la medida en que documenta que el hirudin se evalúa y se utiliza como reactivo anticoagulante en un contexto diagnóstico clínico. Sin embargo, la conexión con la hirudoterapia es completamente indirecta: el resumen discute el hirudin puramente como un reactivo anticoagulante de laboratorio sin que intervengan sanguijuelas, terapia con sanguijuelas, saliva ni secretoma salival, y el propósito del estudio es la metodología de pruebas diagnósticas y no ninguna aplicación terapéutica.
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Añadido a la biblioteca ASH: March 18, 2026 · Última actualización del sitio: June 18, 2026