PMID- 27543785
OWN - NLM
STAT- MEDLINE
DCOM- 20180103
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7836 (Linking)
VI  - 14
IP  - 11
DP  - 2016 Nov
TI  - A comparison of red blood cell transfusion utilization between anti-activated 
      factor X and activated partial thromboplastin monitoring in patients receiving 
      unfractionated heparin.
PG  - 2148-2157
LID - 10.1111/jth.13476 [doi]
AB  - Essentials Anti-activated factor X (Anti-Xa) monitoring is more precise than 
      activated partial thromboplastin (aPTT). 20 804 hospitalized cardiovascular 
      patients monitored with Anti-Xa or aPTT were analyzed. Adjusted transfusion rates 
      were significantly lower for patients monitored with Anti-Xa. Adoption of Anti-Xa 
      protocols could reduce transfusions among cardiovascular patients in the US. 
      SUMMARY: Background Anticoagulant activated factor X protein (Anti-Xa) has been 
      shown to be a more precise monitoring tool than activated partial thromboplastin 
      time (aPTT) for patients receiving unfractionated heparin (UFH) anticoagulation 
      therapy. Objectives To compare red blood cell (RBC) transfusions between patients 
      receiving UFH who are monitored with Anti-Xa and those monitored with aPTT. 
      Patients/Methods A retrospective cohort study was conducted on patients diagnosed 
      with acute coronary syndrome (ACS) (N = 14 822), diagnosed with ischemic stroke 
      (STK) (N = 1568) or with a principal diagnosis of venous thromboembolism (VTE) (N 
      = 4414) in the MedAssets data from January 2009 to December 2013. Anti-Xa and 
      aPTT groups were identified from hospital billing details, with both brand and 
      generic name as search criteria. Propensity score techniques were used to match 
      Anti-Xa cases to aPTT controls. RBC transfusions were identified from hospital 
      billing data. Multivariable logistic regression was used to identify significant 
      drivers of transfusions. Results Anti-Xa patients had fewer RBC transfusions than 
      aPTT patients in the ACS population (difference 17.5%; 95% confidence interval 
      [CI] 16.4-18.7%), the STK population (difference 8.2%; 95% CI 4.4-11.9%), and the 
      VTE population (difference 4.7%; 95% CI 3.3-6.1%). After controlling for patient 
      age and gender, diagnostic risks (e.g. anemia, renal insufficiency, and trauma), 
      and invasive procedures (e.g. cardiac catheterization, hemodialysis, and coronary 
      artery bypass graft), Anti-Xa patients were less likely to have a transfusion 
      while hospitalized for ACS (odds ratio [OR] 0.16, 95% CI 0.14-0.18), STK (OR 
      0.41, 95% CI 0.29-0.57), and VTE (OR 0.35, 95% CI 0.26-0.48). Conclusion Anti-Xa 
      monitoring was associated with a significant reduction in RBC transfusions as 
      compared with aPTT monitoring alone.
CI  - (c) 2016 The Authors. Journal of Thrombosis and Haemostasis published by Wiley 
      Periodicals, Inc. on behalf of International Society on Thrombosis and 
      Haemostasis.
FAU - Belk, K W
AU  - Belk KW
AD  - MedAssets, Inc., Health Data Analytics, Charlotte, NC, USA.
FAU - Laposata, M
AU  - Laposata M
AD  - Department of Pathology, University of Texas Medical Branch-Galveston, Galveston, 
      TX, USA.
FAU - Craver, C
AU  - Craver C
AD  - MedAssets, Inc., Health Data Analytics, Charlotte, NC, USA.
AD  - College of Health and Human Services, University of North Carolina-Charlotte, 
      Charlotte, NC, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20161028
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)
RN  - 9035-58-9 (Thromboplastin)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Algorithms
MH  - Anticoagulants/*therapeutic use
MH  - Blood Transfusion
MH  - Cardiovascular Diseases/blood/immunology
MH  - Comorbidity
MH  - Drug Monitoring/methods
MH  - Erythrocyte Transfusion
MH  - Erythrocytes/*cytology
MH  - Factor Xa/*therapeutic use
MH  - Factor Xa Inhibitors/therapeutic use
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Hospitalization
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - Partial Thromboplastin Time
MH  - Propensity Score
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Thromboplastin/*therapeutic use
MH  - Young Adult
OTO - NOTNLM
OT  - activated partial thromboplastin time
OT  - anticoagulant factor Xa protein
OT  - cardiovascular diseases
OT  - red blood cell transfusions
OT  - unfractionated heparin
EDAT- 2016/10/30 06:00
MHDA- 2018/01/04 06:00
CRDT- 2016/08/21 06:00
PHST- 2015/08/27 00:00 [received]
PHST- 2016/07/14 00:00 [accepted]
PHST- 2016/10/30 06:00 [pubmed]
PHST- 2018/01/04 06:00 [medline]
PHST- 2016/08/21 06:00 [entrez]
AID - S1538-7836(22)03377-3 [pii]
AID - 10.1111/jth.13476 [doi]
PST - ppublish
SO  - J Thromb Haemost. 2016 Nov;14(11):2148-2157. doi: 10.1111/jth.13476. Epub 2016 
      Oct 28.