Anthony F Pizon1, David H Jang, Henry E Wang. 1. Department of Emergency Medicine, Division of Medical Toxicology, University of Pittsburgh School of Medicine, PA, USA.
Abstract
OBJECTIVES: In the treatment of acetaminophen toxicity, clinicians believe that N-acetylcysteine (NAC) artificially elevates prothrombin time (PT), potentially obscuring signs of liver damage. However, the effect of NAC on human blood coagulation remains unverified. The purpose of this study was to evaluate the effect of NAC on PT prolongation in human plasma. METHODS: The authors obtained blood samples from 33 volunteer subjects. The blood plasma samples were divided into four 1-mL aliquots. The first aliquot was used as a control. To three additional aliquots, varying amounts of NAC were added, maintaining constant volume with a maximum dilution of 0.5%. The four concentrations of NAC (control, 250, 500, or 1,000 mg/L) were incubated at 37°C for 1 hour, and PT was measured. PT values were compared using fixed effects regression. RESULTS: Mean (± standard deviation [SD]) PT values for the control, 100, 500, and 1,000 mg/L NAC values were 13.9 (±1.01), 14.2 (±1.08), 15.5 (±1.21), and 17.4 (±1.72) seconds, respectively. At the 1,000 mg/L concentration, two PTs exceeded 22 seconds, and half exceeded 17 seconds. PT increased with NAC concentrations (fixed effects regression p < 0.001) in a dose-dependent manner. CONCLUSIONS: In this in vitro human model, NAC had a dose-dependent effect on PT.
OBJECTIVES: In the treatment of acetaminophentoxicity, clinicians believe that N-acetylcysteine (NAC) artificially elevates prothrombin time (PT), potentially obscuring signs of liver damage. However, the effect of NAC on humanblood coagulation remains unverified. The purpose of this study was to evaluate the effect of NAC on PT prolongation in human plasma. METHODS: The authors obtained blood samples from 33 volunteer subjects. The blood plasma samples were divided into four 1-mL aliquots. The first aliquot was used as a control. To three additional aliquots, varying amounts of NAC were added, maintaining constant volume with a maximum dilution of 0.5%. The four concentrations of NAC (control, 250, 500, or 1,000 mg/L) were incubated at 37°C for 1 hour, and PT was measured. PT values were compared using fixed effects regression. RESULTS: Mean (± standard deviation [SD]) PT values for the control, 100, 500, and 1,000 mg/L NAC values were 13.9 (±1.01), 14.2 (±1.08), 15.5 (±1.21), and 17.4 (±1.72) seconds, respectively. At the 1,000 mg/L concentration, two PTs exceeded 22 seconds, and half exceeded 17 seconds. PT increased with NAC concentrations (fixed effects regression p < 0.001) in a dose-dependent manner. CONCLUSIONS: In this in vitro human model, NAC had a dose-dependent effect on PT.
Authors: Piotr Rzymski; Piotr Klimaszyk; Włodzimierz Marszelewski; Dariusz Borowiak; Mirosław Mleczek; Kamil Nowiński; Bożena Pius; Przemysław Niedzielski; Barbara Poniedziałek Journal: Environ Sci Pollut Res Int Date: 2017-07-25 Impact factor: 4.223