PMID- 19017257
OWN - NLM
STAT- MEDLINE
DCOM- 20090227
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7836 (Linking)
VI  - 7
IP  - 1
DP  - 2009 Jan
TI  - Interlaboratory agreement in the monitoring of unfractionated heparin using the 
      anti-factor Xa-correlated activated partial thromboplastin time.
PG  - 80-6
LID - 10.1111/j.1538-7836.2008.03224.x [doi]
AB  - BACKGROUND: In an effort to improve interlaboratory agreement in the monitoring 
      of unfractionated heparin (UFH), the College of American Pathologists (CAP) 
      recommends that the therapeutic range of the activated partial thromboplastin 
      time (APTT) be defined in each laboratory through correlation with a direct 
      measure of heparin activity such as the factor Xa inhibition assay. Whether and 
      to what extent this approach enhances the interlaboratory agreement of UFH 
      monitoring has not been reported. OBJECTIVES: We conducted a cross-validation 
      study among four CAP-accredited coagulation laboratories to compare the 
      interlaboratory agreement of the anti-FXa-correlated APTT with that of the 
      traditional 1.5-2.5 times the midpoint of normal (1.5-2.5:control) method for 
      defining the therapeutic APTT range. PATIENTS AND METHODS: APTT and FXa 
      inhibition assays were performed in each laboratory on plasma samples from 44 
      inpatients receiving UFH. RESULTS: Using the anti-FXa-correlation method, there 
      was agreement among all four laboratories as to whether a sample was 
      subtherapeutic, therapeutic or supratherapeutic in seven (16%) patient samples. 
      In contrast, consensus was achieved in 23 (52%) samples when the 1.5-2.5:control 
      method was employed. CONCLUSIONS: The anti-FXa-correlation method does not appear 
      to enhance interlaboratory agreement in UFH monitoring as compared with the 
      traditional 1.5-2.5:control method. Adoption of the anti-FXa-correlation method 
      produces considerable disparity in UFH dosing decisions among different centers, 
      although the clinical impact of this disparity is not known.
FAU - Cuker, A
AU  - Cuker A
AD  - Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 
      adam.cuker@uphs.upenn.edu
FAU - Ptashkin, B
AU  - Ptashkin B
FAU - Konkle, B A
AU  - Konkle BA
FAU - Pipe, S W
AU  - Pipe SW
FAU - Whinna, H C
AU  - Whinna HC
FAU - Zheng, X L
AU  - Zheng XL
FAU - Cines, D B
AU  - Cines DB
FAU - Pollak, E S
AU  - Pollak ES
LA  - eng
GR  - HL081012/HL/NHLBI NIH HHS/United States
GR  - HL084006/HL/NHLBI NIH HHS/United States
GR  - T32 HL07971/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20081111
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - J Thromb Haemost. 2009 Dec;7(12):2157-8; author reply 2178-9. PMID: 19765209
MH  - Anticoagulants/pharmacokinetics
MH  - Clinical Laboratory Techniques/standards
MH  - Drug Monitoring/*methods/standards
MH  - Factor Xa Inhibitors
MH  - Heparin
MH  - Humans
MH  - Observer Variation
MH  - Partial Thromboplastin Time/*standards
MH  - *Practice Guidelines as Topic
MH  - Reference Values
EDAT- 2008/11/20 09:00
MHDA- 2009/02/28 09:00
CRDT- 2008/11/20 09:00
PHST- 2008/11/20 09:00 [pubmed]
PHST- 2009/02/28 09:00 [medline]
PHST- 2008/11/20 09:00 [entrez]
AID - S1538-7836(22)12517-1 [pii]
AID - 10.1111/j.1538-7836.2008.03224.x [doi]
PST - ppublish
SO  - J Thromb Haemost. 2009 Jan;7(1):80-6. doi: 10.1111/j.1538-7836.2008.03224.x. Epub 
      2008 Nov 11.