Polyvinylpyrrolidone induced artefactual prolongation of activated partial thromboplastin times in intravenous drug users with renal failure

Abstract

To cite this article: Kristoffersen AH, Bj anes TK, Jordal S, Leh S, Leh F, Svarstad E. Polyvinylpyrrolidone induced artefactual prolongation of activated partial thromboplastin times in intravenous drug users with renal failure. J Thromb Haemost 2016; 14: 936-9. EssentialsProlonged activated partial thromboplastin times (APTT) were found in drug users with renal failure. An oral methadone solution containing polyvinylpyrrolidone (PVP) had been injected intravenously. Spiking normal plasma with increasing concentrations of PVP resulted in artifically prolonged APTT. APTT prolongation may indicate PVP deposits as underlying cause in patients with renal failure.Summary. Unexpectedly prolonged activated partial thromboplastin times (APTTs) were noted in several patients with chronic renal insufficiency and a history of intravenous drug abuse. Deposits of polyvinylpyrrolidone (PVP), an excipient in one oral methadone solution used in opioid maintenance programs, were found in renal biopsies. One case is described in detail, and this is followed by a summary of findings in 11 other patients and the results of an in vitro experiment in which plasma was spiked with PVP at increasing concentrations. APTTs measured with STA PTT automate (Stago) were prolonged in all patients and in spiked samples, whereas supplemental coagulation parameters and APTTs measured with HemosIL SynthAsil or Actin FSL (Siemens) were within reference intervals. These results indicate that interference with APTTs by PVP is reagent-dependent.We suggest that a prolonged APTT should raise the suspicion of PVP deposit-associated kidney disease in patients with chronic renal failure and a history of intravenous drug abuse.

Chronic Kidney Disease from Polyvinylpyrrolidone Deposition in Persons with Intravenous Drug Use

“…Starting in 2009, pathology departments in Norway received biopsies from patients with opioid addiction and IV drug use showing deposits of polyvinylpyrrolidone (PVP) (9 –12), a common excipient in pharmaceuticals (13). Moderate and high molecular weight PVP is exclusively utilized in oral and topical medications (13), as it may accumulate in the body if injected (14,15).…”

Case Report: Polyvinylpyrrolidone deposition disease from repeated injection of opioid substitution drugs: report of a case with a fatal outcome

“…6 It is therefore plausible that injections of the PVP K90-containing methadone syrup were the cause of the PVP-deposition disease in this patient. Based on the history of this patient and other similar cases, 15,16 the European Medicines Agency suspended this methadone syrup in 2014. 14…”