PMID- 27856667
OWN - NLM
STAT- MEDLINE
DCOM- 20180717
LR  - 20200225
IS  - 1938-2723 (Electronic)
IS  - 1076-0296 (Print)
IS  - 1076-0296 (Linking)
VI  - 24
IP  - 1
DP  - 2018 Jan
TI  - Protocolled Redefinition of the Therapeutic Range for Unfractionated Heparin: 
      Lost in Translation?
PG  - 164-171
LID - 10.1177/1076029616679508 [doi]
AB  - BACKGROUND: Protocolled treatment with unfractionated heparin (UFH) is a subject 
      of ongoing debate. Even though international guidelines prescribe calibration of 
      the activated partial thromboplastin time (aPTT) to 0.3 to 0.7 U/mL anti-Xa 
      activity to establish an UFH therapeutic range, evidence for this approach 
      remains scarce. In this study, we evaluated different strategies to delineate the 
      UFH therapeutic range and analyzed the effects on patient therapeutic 
      classification. METHODS: In 109 patient samples, the aPTT was measured with 2 
      different reagents, both of which used mechanical clot detection. The UFH 
      therapeutic range was determined using 3 previously described methods: 
      calibration of the aPTT to 0.3 to 0.7 U/mL anti-Xa activity, application of 1.5 
      to 2.5 times the control aPTT, or using 0.3 to 0.7 U/mL anti-Xa activity 
      directly. We also applied the UFH therapeutic range of a second hospital to our 
      patient population. RESULTS: Application of the guideline-prescribed anti-Xa 
      calibration method would result in patients receiving increased UFH dosage in 
      comparison to our previous UFH nomogram. Between-method and between-laboratory 
      variations in aPTT and anti-Xa activity assays are a likely cause of these 
      discrepancies. Additionally, we show that individual patient characteristics, 
      such as weight and UFH treatment duration, likely contribute to the discordance 
      between different strategies to establish an UFH therapeutic range. CONCLUSION: 
      No consensus is reached between different strategies to define the UFH 
      therapeutic range, which could result in relevant differences in UFH doses 
      applied in patients. Clinicians and laboratory specialists should critically 
      evaluate UFH monitoring protocols and be aware of their shortcomings.
FAU - Coene, Karlien L M
AU  - Coene KLM
AD  - 1 Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.
FAU - van der Graaf, Fedde
AU  - van der Graaf F
AD  - 2 Clinical Laboratory, Maxima Medical Centre, Veldhoven, the Netherlands.
FAU - van de Kerkhof, Daan
AU  - van de Kerkhof D
AD  - 1 Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20161116
PL  - United States
TA  - Clin Appl Thromb Hemost
JT  - Clinical and applied thrombosis/hemostasis : official journal of the 
      International Academy of Clinical and Applied Thrombosis/Hemostasis
JID - 9508125
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Calibration
MH  - Female
MH  - Heparin/*administration & dosage/*pharmacokinetics
MH  - Humans
MH  - Male
MH  - Partial Thromboplastin Time/methods/standards
MH  - *Thrombolytic Therapy
PMC - PMC6714639
OTO - NOTNLM
OT  - activated partial thromboplastin time
OT  - anti-Xa activity
OT  - therapeutic drug monitoring
OT  - unfractionated heparin
COIS- Declaration of Conflicting Interests: The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2016/11/20 06:00
MHDA- 2018/07/18 06:00
PMCR- 2016/11/16
CRDT- 2016/11/19 06:00
PHST- 2016/11/20 06:00 [pubmed]
PHST- 2018/07/18 06:00 [medline]
PHST- 2016/11/19 06:00 [entrez]
PHST- 2016/11/16 00:00 [pmc-release]
AID - 1076029616679508 [pii]
AID - 10.1177_1076029616679508 [pii]
AID - 10.1177/1076029616679508 [doi]
PST - ppublish
SO  - Clin Appl Thromb Hemost. 2018 Jan;24(1):164-171. doi: 10.1177/1076029616679508. 
      Epub 2016 Nov 16.