Subscribe to RSS
DOI: 10.1055/s-0038-1647317
Prediction of Vitamin K Response Using the Echis Time and Echis-Prothrombin Time Ratio
Publication History
Received 13 February 1990
Accepted after revision08 June 1990
Publication Date:
04 September 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/199003/lookinside/thumbnails/10-1055-s-0038-1647317-1.jpg)
Summary
Echis carinatus venom contains proteases capable of activating both normal and descarboxy prothrombin. We showed this venom (Sigma) principally activates prothrombin with almost no factor X activation. Echis time in combination with prothrombin time can predict vitamin K responsiveness since the Echis time is usually normal in the presence of descarboxy prothrombin associated with vitamin K deficiency.
38 patients with abnormal routine prothrombin times (PT) had both coagulant and immunogenic factor II assays along with Echis times done before and after vitamin K. Of 22 patients responding to vitamin K, based on correction of PT, 21 had normal initial Echis times and of 16 not responding, 11 had abnormal Echis times, giving a sensitivity of 95.4% and specificity of 68.8% for vitamin K responsiveness. 90% of patients with a PT/Echis time ratio <1.3 and a prolonged Echis time did not correct their PTs with vitamin K therapy.
The 5 non-responders with normal Echis times all showed normal initial coagulant and antigenic prothrombin, but 3 had low F V and/or F VII.
-
References
- 1 Lindhout MJ, Kop-Klaassen BH M, Kop JM N, Hemker HC. Purification and properties of phenprocoumon-induced descarboxy factor X from bovine plasma - A comparison to normal factor X. Biochim Biophys Acta 1978; 533: 302-317
- 2 Malhotra OP. Purification and characterization of Dicoumarol induced prothrombins. Thromb Res 1979; 15: 427-463
- 3 Malhotra OP. Electroimmunoassay of prothrombin. Thromb Res 1987; 47: 493-500
- 4 Orstavik KH, Laake K. Factor IX in warfarin treated patients. Thromb Res 1978; 132: 207-218
- 5 Reekers PP N, Lindhout MJ, Kop-Klassen BH M, Hemker HC. Demonstration of three anomalous plasma proteins induced by a Vitamin K antagonist. Biochim Biophys Acta 1973; 317: 559-562
- 6 Aronson DL, Franza BR, Bagley J. The use of prothrombin activating snake venoms to measure human prethrombin 2. Thromb Res 1984; 34: 419-429
- 7 Briet E, Noyes CM, Roberts HR, Griffith MJ. Cleavage and activation of human prothrombin by Echis carinatus venom. Thromb Res 1982; 27: 591-600
- 8 Denson KW E. Clot inducing substances present in snake venoms with particular reference to Echis carinatus. Thromb Res 1976; 8: 351-360
- 9 Dyr JE, Blomback B, Kornalik F. The action of prothrombin activated by Ecarin on fibrinogen. Thromb Res 1983; 30: 225-234
- 10 Stocker K, Fischer H, Brogli M. Determination of factor X activator in the venom of the saw scaled viper Echis carinatus. Toxicon 1986; 243: 313-315
- 11 Stocker K, Fischer H, Brogle M. Chromogenic assay for the prothrombin activator Ecarin from the venom of the saw scale viper Echis carinatus. Toxicon 1986; 241: 81-89
- 12 Bertina RM, Westhoek-Kuipers ME J, Alderkamp GH J. The inhibitor of prothrombin conversion in plasma of patients on oral anticoagulant treatment. Thromb Haemostas 1981; 453: 237-241
- 13 Corrigan JJ, Earnest DL. Factor II antigen in liver disease and warfarin induced vitamin K deficiency. Correlation with coagulant activity using Echis venom. Am J Hematol 1980; 8: 249-255
- 14 Mackie IJ, Walshe K, Cohen H, McCarthy P, Shearer M, Scott SD, Karran SJ, Machin SJ. Effects of N-methyl thiotetrazole cephalosporin on haemostasis in patients with reduced serum vitamin IQ concentrations. J Clin Pathol 1986; 39: 1245-1249
- 15 Bertina RM, Van der Marel-Van Nieuwkoop W, Dubbeldam J, Boekhout-Mussert RJ, Veltkamp JJ. New method for the rapid detection of vitamin K deficiency. Clin Chim Acta 1980; 105: 93-98
- 16 Schultz von F-H. Eine einfache Bewertungsmethode von Leberparenchymschaden (volumetrische Fibrinbestimmung). Acta Hepatolog 1955; 3: 306-310
- 17 Hemker HC, Van Dam-Mieras MC E, Devilee PD. The action of Echis carinatus venom on the blood coagulation system. Demonstration of an activator of factor X. Thromb Res 1984; 35: 1-9
- 18 Fujimura Y, Mimura Y, Kinoshita S, Yoshioka A, Kitanaki T, Yoshioka K, Takamiya O. Studies on vitamin K dependent factor deficiency during early childhood with special reference to prothrombin activity and antigen level. Haemostasis 1982; 11: 90-95
- 19 Fujimura Y, Okubo Y, Sakai T, Sugimoto M, Takase T, Yoshioka A, Fukui H. Studies on precursor proteins PIVKA II, IX, X in the plasma of patients with haemorrhagic disease of the newborn. Haemostasis 1984; 14: 211-217
- 20 Goldschmidt B, Bors S, Szabo A. Vitamin K dependent clotting factors during long term parenteral nutrition in full-term and pre-term infants. J Pediatr 1988; 1121: 108-111
- 21 Von Kries R, Kreppel S, Becker A, Tangermann R, Gobel V. Acarboxyprothrombin activity after oral prophylactic vitamin-K. Arch Dis Child 1987; 62: 938-940