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Effects of telavancin on coagulation test results
S L Barriere1, M R Goldberg, J W Janc
1Theravance, Inc., South San Francisco, CA 94080, USA. sbarriere@theravance.com
Background:
The lipoglycopeptide antibiotic, telavancin, may interfere with some laboratory coagulation tests including prothrombin time (PT) and activated partial thromboplastin time (aPTT).
Objective:
To evaluate the effects of telavancin on PT and aPTT assays in common use.
Methods:
Pooled normal human plasma was spiked with telavancin 10, 20, 100 or 200 μg/ml (equivalent to trough, 2 × trough, peak and 2 × peak clinical plasma concentrations, respectively) or diluent control (0.9% sodium chloride). Samples were analysed using 16 PT reagents and seven aPTT reagents.
Results:
Telavancin 200 μg/ml (corresponding to 2 × peak clinical plasma concentration), produced significant PT prolongation (> 9% difference vs. diluent control) with all the 16 PT reagents (range 12% to > 600%). At lower telavancin concentrations, PT prolongation was dose-dependent and varied among reagents, but appeared greatest with preparations containing recombinant tissue factor. With telavancin 10 μg/ml (equivalent to trough), PT prolongation was 10% with HemosIL(®) PT-Fibrinogen Recombinant, while ranging from 5% to -1% with all other reagents. Significant (> 34% difference vs. baseline) and dose-dependent aPTT prolongation was observed with all the seven reagents in samples spiked with telavancin 100 or 200 μg/ml (range 65-142% at 200 μg/ml). aPTT reagents containing a silica activator appeared to be more sensitive to telavancin interference. Telavancin 10 μg/ml was not associated with increased aPTT with any of the reagents tested.
Conclusions:
Telavancin has the potential to prolong both PT and aPTT in vitro. It is recommended that samples for PT or aPTT be obtained just prior to a telavancin dose (trough).
Insights
Telavancin can interfere with laboratory coagulation tests, prolonging prothrombin time (PT) and activated partial thromboplastin time (aPTT). Collect blood for these tests at trough telavancin concentrations to minimize interference.
Area of Science:
- Clinical Chemistry
- Pharmacology
- Hematology
Background:
- Telavancin, a lipoglycopeptide antibiotic, is known to potentially interfere with coagulation assays.
- This interference can affect the accuracy of critical laboratory tests such as prothrombin time (PT) and activated partial thromboplastin time (aPTT).
Purpose of the Study:
- To investigate the impact of telavancin on commonly used PT and aPTT laboratory assays.
- To determine the extent and conditions under which telavancin causes interference in coagulation testing.
Main Methods:
- Normal human plasma was treated with varying concentrations of telavancin (10-200 μg/ml).
- Plasma samples were analyzed using 16 different PT reagents and 7 different aPTT reagents.
- Telavancin concentrations mimicked clinical trough, 2x trough, peak, and 2x peak levels.
Main Results:
- Telavancin significantly prolonged PT across all 16 reagents at 200 μg/ml, with dose-dependent effects observed at lower concentrations.
- PT prolongation was more pronounced with reagents containing recombinant tissue factor.
- Significant, dose-dependent aPTT prolongation occurred with all 7 reagents at 100 and 200 μg/ml, particularly with silica-activated reagents.
Conclusions:
- Telavancin can interfere with PT and aPTT assays in vitro, leading to prolonged results.
- To ensure accurate coagulation test results, it is recommended to collect samples just before the next telavancin dose (trough concentration).
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