PMID- 25319855
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20161230
IS  - 1872-9061 (Electronic)
IS  - 0300-2977 (Linking)
VI  - 72
IP  - 6
DP  - 2014 Jul
TI  - Accuracy of aPTT monitoring in critically ill patients treated with 
      unfractionated heparin.
PG  - 305-10
AB  - INTRODUCTION: The anticoagulant effect of unfractionated heparin (UFH) is usually 
      monitored by means of the activated partial thromboplastin time (aPTT). In 
      critically ill patients, however, increased levels of acute phase proteins may 
      decrease the accuracy of the aPTT, leading to inadequate UFH dosing. In these 
      circumstances, the anti-Xa assay is recommended for monitoring. OBJECTIVE: We 
      aimed to analyse the accuracy of the aPTT for the monitoring of UFH dosing in 
      critically ill patients. METHODS: In critically ill patients treated with 
      therapeutic doses of UFH, we compared aPTT levels with simultaneously measured 
      anti-Xa levels as the gold standard. Sensitivity and specificity of the aPTT were 
      determined for different cut-off points, receiver operating characteristic (ROC) 
      curves were constructed and their areas under the curve (AUCs) were calculated. 
      RESULTS: A total of 171 paired blood samples from 58 patients were analysed. 
      Concordant aPTT and anti-Xa values were observed in 108 (63.2%) data pairs. In 33 
      data pairs (19.3%) the aPTT was discordantly high and in 30 data pairs (17.5%) 
      discordantly low. The sensitivity of the aPTT in detecting UFH underdosing and 
      overdosing was 0.63 and 0.37, respectively. When considering alternative 
      thresholds, ROC curves for underdosing and overdosing had AUCs of 0.71 and 0.81, 
      respectively. CONCLUSION: In this small cohort of critically ill patients, the 
      aPTT was accurate in 63.2% of the blood samples. Its sensitivity to detect UFH 
      underdosing and overdosing was low (0.63 and 0.37, respectively). We conclude 
      that in critically ill patients, the aPTT is not accurate enough to detect UFH 
      underdosing and overdosing.
FAU - van Roessel, S
AU  - van Roessel S
AD  - Department of Vascular Medicine, Academic Medical Center, Amsterdam, the 
      Netherlands.
FAU - Middeldorp, S
AU  - Middeldorp S
FAU - Cheung, Y W
AU  - Cheung YW
FAU - Zwinderman, A H
AU  - Zwinderman AH
FAU - de Pont, A C J M
AU  - de Pont AC
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - Netherlands
TA  - Neth J Med
JT  - The Netherlands journal of medicine
JID - 0356133
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - *Critical Illness
MH  - Dose-Response Relationship, Drug
MH  - Drug Monitoring/methods
MH  - Factor Xa Inhibitors/blood
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Netherlands
MH  - Partial Thromboplastin Time/*methods
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
EDAT- 2014/10/17 06:00
MHDA- 2016/12/15 06:00
CRDT- 2014/10/17 06:00
PHST- 2014/10/17 06:00 [entrez]
PHST- 2014/10/17 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
PST - ppublish
SO  - Neth J Med. 2014 Jul;72(6):305-10.