PMID- 27919873
OWN - NLM
STAT- MEDLINE
DCOM- 20180126
LR  - 20190101
IS  - 1535-2900 (Electronic)
IS  - 1079-2082 (Linking)
VI  - 73
IP  - 24
DP  - 2016 Dec 15
TI  - Managing transitions from oral factor Xa inhibitors to unfractionated heparin 
      infusions.
PG  - 2037-2041
AB  - PURPOSE: Published evidence regarding the effects of oral factor Xa inhibitors on 
      anticoagulation monitoring tests is reviewed with a focus on monitoring concerns 
      that can arise during transitions to i.v. heparin therapy. SUMMARY: Assays that 
      measure inhibition of factor Xa activity (i.e., anti-Xa assays) are widely used 
      in U.S. institutions to monitor i.v. heparin therapy and, in some cases, for 
      monitoring other types of anticoagulation therapy. Clinicians have raised 
      concerns that the use of anti-Xa assays to monitor heparin levels in hospitalized 
      patients who must be transitioned from oral factor Xa inhibitor therapy to i.v. 
      unfractionated heparin (UFH) infusions could yield unquantifiable or inaccurate 
      results, leading to unnecessary UFH dose reductions and potential treatment 
      failures; the manufacturer labeling of oral factor Xa inhibitors (apixaban, 
      edoxaban, and rivaroxaban) does not provide specific guidance on this issue. 
      Results of a literature review indicated that residual effects of oral factor Xa 
      inhibitor use can result in substantial interference with the currently available 
      chromogenic anti-Xa assays but negligible to moderate effects on global 
      coagulation assays, which measure activated partial thromboplastin time (aPTT) or 
      prothrombin time. Therefore, during the transition from an oral factor Xa 
      inhibitor to i.v. UFH therapy, it may be prudent to consider an aPTT assay for 
      anticoagulation monitoring. CONCLUSION: The use of oral factor Xa inhibitors 
      appears to affect the accuracy of anti-Xa assay results, with results of global 
      coagulation assays affected to a lesser degree.
CI  - Copyright (c) 2016 by the American Society of Health-System Pharmacists, Inc. All 
      rights reserved.
FAU - Faust, Andrew C
AU  - Faust AC
AD  - Department of Pharmacy, Texas Health Presbyterian Hospital of Dallas, Dallas, TX. 
      andrewfaust@texashealth.org.
FAU - Kanyer, Dave
AU  - Kanyer D
AD  - Community Hospital of the Monterey Peninsula, Monterey, CA.
FAU - Wittkowsky, Ann K
AU  - Wittkowsky AK
AD  - Department of Pharmacy, University of Washington, Seattle, WA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Administration, Oral
MH  - Anticoagulants/*administration & dosage/blood
MH  - Blood Coagulation/drug effects/physiology
MH  - Drug Monitoring/methods
MH  - Drug Substitution/*methods
MH  - Factor Xa Inhibitors/*administration & dosage/blood
MH  - Heparin/*administration & dosage/blood
MH  - Humans
MH  - Infusions, Intravenous
MH  - Prothrombin Time/methods
EDAT- 2016/12/07 06:00
MHDA- 2018/01/27 06:00
CRDT- 2016/12/07 06:00
PHST- 2016/12/07 06:00 [entrez]
PHST- 2016/12/07 06:00 [pubmed]
PHST- 2018/01/27 06:00 [medline]
AID - 73/24/2037 [pii]
AID - 10.2146/ajhp150596 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2016 Dec 15;73(24):2037-2041. doi: 10.2146/ajhp150596.