Impact of Drugs Used in Intensive Care on Routine Coagulation Testing

Area of Science:

• Clinical Chemistry
• Pharmacology
• Critical Care Medicine

Background:

• Coagulation testing is vital in ICUs for managing hemostasis, assessing bleeding risk, and guiding therapy.
• Numerous drugs used in critical care can interfere with coagulation assays, either in vitro or in vivo.
• A comprehensive review of these drug interferences on coagulation assays is lacking.

Purpose of the Study:

• To critically analyze the literature on drug interferences with common coagulation assays.
• To define the impact of specific drugs on chromogenic and chronometric assays.
• To outline the consequences of these interferences on patient management in the ICU.

Main Methods:

• Literature review and critical analysis.
• Identification of drugs impacting coagulation assays.
• Categorization of interferences as in vitro or in vivo effects.

Main Results:

• Hydroxocobalamin, lipid emulsion, and propofol impact chromogenic assays.
• PEGylated compounds, emicizumab, rFVIIa, antibiotics, and sugammadex affect chronometric assays.
• N-acetylcysteine, SSRIs, and tramadol influence the hemostasis system, posing challenges for anticoagulation management.

Conclusions:

• Drug interferences with coagulation assays are common in ICUs and can affect patient management.
• Understanding these interactions is crucial for accurate interpretation of coagulation tests.
• Further research may be needed to clarify specific mechanisms and clinical implications.