PMID- 24421495
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20140114
LR  - 20240518
IS  - 0018-5787 (Print)
IS  - 1945-1253 (Electronic)
IS  - 0018-5787 (Linking)
VI  - 48
IP  - 5
DP  - 2013 May
TI  - High-Risk Non-ST Elevation Acute Coronary Syndrome Outcomes in Patients Treated 
      with Unfractionated Heparin Monitored Using Anti-Xa Concentrations Versus 
      Activated Partial Thromboplastin Time.
PG  - 389-95
LID - 10.1310/hpj4805-389 [doi]
AB  - BACKGROUND: While the activated partial thromboplastin time (aPTT) is the most 
      widely used assay to monitor unfractionated heparin (UFH), providing a general 
      measure of the extent of anticoagulation, it does not reliably correlate with the 
      blood concentration of heparin or its antithrombotic effect. While cost and 
      availability have limited the widespread use of UFH in hospitals, monitoring UFH 
      with heparin levels has been shown to reduce both the number of monitoring tests 
      and the time to a therapeutic range. OBJECTIVES: To compare outcomes in patients 
      with non-ST elevation acute coronary syndrome (ACS) treated with weight-based UFH 
      monitored with anti-Xa concentrations versus aPTT. METHODS: A retrospective chart 
      review was completed in patients admitted with high-risk ACS and compared to the 
      UFH arm of the SYNERGY trial. The primary outcome included the clinical endpoint 
      of all-cause death or non-fatal myocardial infarction until time of hospital 
      discharge. Safety endpoints evaluated included incidence of stroke and major 
      bleeding. RESULTS: The primary endpoint occurred in 6.3% of patients in the study 
      cohort compared to 6.5% of patients in the heparin arm of the SYNERGY trial at 48 
      hours (P = .006). Bleeding was reduced in the study cohort with a significant 
      decrease in GUSTO severe bleeding (P = .007). Additionally the study cohort had 
      significantly fewer patients with an absolute drop in hemoglobin or hematocrit. 
      Thrombolysis in Myocardial Infarction (TIMI) major and minor bleeding, rate of 
      transfusion, and platelet counts were similar between groups. CONCLUSIONS: 
      Outcomes for high-risk ACS patients receiving heparin monitored by anti-Xa 
      concentrations are noninferior to heparin monitored by aPTT.
FAU - Hamilton, Leslie A
AU  - Hamilton LA
AD  - Department of Clinical Pharmacy, University of Tennessee Health Science Center, 
      College of Pharmacy, Knoxville, Tennessee;
FAU - Abbott, Gregory V
AU  - Abbott GV
AD  - Department of Pharmacy, Cone Health, Greensboro, North Carolina.
FAU - Cooper, Julie B
AU  - Cooper JB
AD  - Department of Pharmacy, Cone Health, Greensboro, North Carolina.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Hosp Pharm
JT  - Hospital pharmacy
JID - 0043175
PMC - PMC3839461
OTO - NOTNLM
OT  - acute coronary syndrome
OT  - heparin
OT  - non-ST elevation myocardial infarction
EDAT- 2014/01/15 06:00
MHDA- 2014/01/15 06:01
PMCR- 2013/05/06
CRDT- 2014/01/15 06:00
PHST- 2014/01/15 06:00 [entrez]
PHST- 2014/01/15 06:00 [pubmed]
PHST- 2014/01/15 06:01 [medline]
PHST- 2013/05/06 00:00 [pmc-release]
AID - hpj480509 [pii]
AID - 10.1310/hpj4805-389 [doi]
PST - ppublish
SO  - Hosp Pharm. 2013 May;48(5):389-95. doi: 10.1310/hpj4805-389.