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We tested a mechanized amidolytic factor-X assay in 2222 patients on long term anticoagulant therapy. A good correlation was found between this assay and the routinely performed Thrombotest (r= 0.78). With a therapeutic range between 150 and 300 units/L of factor-X amidolytic activity we obtained the same information about the state of anticoagulation in 81 % of these 2222 patients. Factor-X activity was assayed in 32 stable anticoagulated patients together with Thrombotest on at least three subsequent occasions in each patient. A fairly constant Thrombotest-factor X ratio was observed.(mean 0.38±0.06) Changes in Thrombotest and factor-X amidolytic activity ran consistently parallel in a group of 20 unstable anticoagulated patients.(mean ratio 0.45±0.08) Changes in Thrombotest were occasionally more pronounced than changes in factor-X activity in some patients, which could be due to the high turnover of factor VII. Relative very high or low factor-VII levels as compared to the other vitamin-K dependent factors disturbed the balance between Thrombotest and factor X. The therapeutic consequence in these unbalanced states is, that the prescribed dosage scheme of the anti-vitamin K drug could depend on the very moment of blood sampling. As a result of the high turnover of factor VII, bloodsampling one day earlier or later would then result in another dosage scheme of the drug. Therefore it might be concluded that oral anticoagulant therapy, guided by a factor-X assay could result in more stable long term treatment. Large prospective comparative trials are required to support this hypothesis.

A Comparison Between Thrombotest And Factor-X Amidolytic Activity In Stable And Non-Stable Anticoagulated Patients