PMID- 27381025
OWN - NLM
STAT- MEDLINE
DCOM- 20170426
LR  - 20170426
IS  - 1365-2710 (Electronic)
IS  - 0269-4727 (Linking)
VI  - 41
IP  - 5
DP  - 2016 Oct
TI  - Antifactor Xa levels vs. activated partial thromboplastin time for monitoring 
      unfractionated heparin. A pilot study.
PG  - 499-502
LID - 10.1111/jcpt.12415 [doi]
AB  - WHAT IS KNOWN AND OBJECTIVES: The two most common methods for monitoring 
      unfractionated heparin (UFH) infusion are the activated partial thromboplastin 
      time (aPTT) and the antifactor Xa heparin assay (anti-Xa). The purpose of this 
      study is to compare the performance of an aPTT protocol vs. an anti-Xa protocol 
      in adult patients as defined by the time to reach therapeutic range, the 
      percentage of time the values were within the goal range and the number of times 
      laboratory monitoring was conducted. We then analysed the discordance between 
      paired values of anti-Xa and aPTT. METHODS: This was a single-centre prospective 
      cohort pilot study conducted from 1 September 2013 to 31 May 2014. RESULTS: 
      Eighty-five patients were treated with UFH infusion, aPTT monitoring (n = 48), 
      anti-Xa monitoring (n = 37). The number of times aPTT and anti-Xa values were 
      ordered was (median, IQR) 14 (2-34) vs 7 (2-76); P = 0.23. The time to reach 
      therapeutic range in hours was (mean, SD) 22 (20) aPTT vs 15 (13) anti-Xa; P = 
      0.08. Therapeutic range (>50-100% of the time) was achieved in only 5 (10%) 
      patients in the aPTT group vs. 21 (57%) in the anti-Xa group; P < 0.01. 
      Supratherapeutic values (>50-100%) were observed in 38 (78%) patients in the aPTT 
      group vs. 14 (38%) in the anti-Xa group; P < 0.01. The discordance between aPTT 
      and anti-Xa was evaluated using 234 paired values from 37 patients. There was 
      discordance between anti-Xa and aPTT values 57% of the time. Two patients had 
      bleeding complications requiring blood transfusion or discontinuation of 
      post-pilot protocol. WHAT IS NEW AND CONCLUSION: Utilizing an anti-Xa protocol to 
      monitor heparin infusion showed favourable results compared with utilizing an 
      aPTT protocol by maintaining values within the therapeutic goal range. The most 
      common discordant pattern in our study was a disproportionate prolongation of 
      aPTT to anti-Xa values. Patients with discordant values presenting with high aPTT 
      to normal anti-Xa values may have an increased risk of bleeding complications.
CI  - (c) 2016 John Wiley & Sons Ltd.
FAU - Samuel, S
AU  - Samuel S
AD  - Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, TX, 
      USA.
FAU - Allison, T A
AU  - Allison TA
AD  - Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, TX, 
      USA.
FAU - Sharaf, S
AU  - Sharaf S
AD  - Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, TX, 
      USA.
FAU - Yau, G
AU  - Yau G
AD  - Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, TX, 
      USA.
FAU - Ranjbar, G
AU  - Ranjbar G
AD  - Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, TX, 
      USA.
FAU - Mckaig, N
AU  - Mckaig N
AD  - Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, TX, 
      USA.
FAU - Nguyen, A
AU  - Nguyen A
AD  - Department of Pathology and Laboratory Medicine, The University of Texas Medical 
      School at Houston, Houston, TX, USA.
FAU - Escobar, M
AU  - Escobar M
AD  - Department of Hematology, The University of Texas Medical School at Houston, 
      Houston, TX, USA.
FAU - Choi, H A
AU  - Choi HA
AD  - Department of Neurosurgery and Neurology, The University of Texas Medical School 
      at Houston, Houston, TX, USA.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20160706
PL  - England
TA  - J Clin Pharm Ther
JT  - Journal of clinical pharmacy and therapeutics
JID - 8704308
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Drug Monitoring/methods
MH  - Factor Xa/*metabolism
MH  - Factor Xa Inhibitors/*therapeutic use
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Infusions, Intravenous/methods
MH  - Male
MH  - Middle Aged
MH  - Partial Thromboplastin Time/methods
MH  - Pilot Projects
MH  - Prospective Studies
OTO - NOTNLM
OT  - activated partial thromboplastin time
OT  - anticoagulation
OT  - antifactor Xa heparin assay
OT  - heparin laboratory monitoring
OT  - unfractionated heparin
OT  - venous thromboembolism
EDAT- 2016/07/07 06:00
MHDA- 2017/04/27 06:00
CRDT- 2016/07/07 06:00
PHST- 2016/02/23 00:00 [received]
PHST- 2016/06/09 00:00 [accepted]
PHST- 2016/07/07 06:00 [entrez]
PHST- 2016/07/07 06:00 [pubmed]
PHST- 2017/04/27 06:00 [medline]
AID - 10.1111/jcpt.12415 [doi]
PST - ppublish
SO  - J Clin Pharm Ther. 2016 Oct;41(5):499-502. doi: 10.1111/jcpt.12415. Epub 2016 Jul 
      6.