PMID- 28632418
OWN - NLM
STAT- MEDLINE
DCOM- 20171009
LR  - 20180225
IS  - 1747-4094 (Electronic)
IS  - 1747-4094 (Linking)
VI  - 10
IP  - 7
DP  - 2017 Jul
TI  - Therapeutic monitoring of unfractionated heparin - trials and tribulations.
PG  - 595-605
LID - 10.1080/17474086.2017.1345306 [doi]
AB  - Heparin is one of the oldest biological medicines with an established role in 
      prevention and treatment of arterial and venous thromboembolism. Published 
      therapeutic ranges for unfractionated heparin (UFH) mostly precede the large 
      increase in the number of activated partial thromboplastin time (APTT) 
      reagent/instrument combinations that now show wide variability. Areas covered: 
      This paper explores the use of UFH, the development of heparin therapeutic ranges 
      (HTRs), and the strengths and limitations of the methods used to monitor 
      heparin's anticoagulant effect. Expert commentary: Despite longstanding use of 
      UFH for management of thromboembolic conditions, the optimal test for monitoring 
      UFH remains undetermined. Although used extensively for monitoring UFH, routine 
      APTT-derived HTRs are based on limited science that may have little relevance to 
      current laboratory practice. Anti-FXa levels may provide better and more reliable 
      HTRs; however, even these levels show considerable inter-laboratory variation, 
      and there are insufficient clinical studies proving improved clinical efficacy. 
      Alternative tests for monitoring UFH reported over time have not been proven 
      effective nor feasible, secondary to technical or cost issues, or lack of general 
      adoption. Thus, despite limited evidence of clinical utility, an uncomfortable 
      marriage of convenience represented by heparin laboratory monitoring is unlikely 
      to be terminated in the immediate future.
FAU - Baluwala, Israfil
AU  - Baluwala I
AD  - a Department of Haematology, Institute of Clinical Pathology and Medical 
      Research, NSW Health Pathology , Westmead Hospital , Westmead , Australia.
FAU - Favaloro, Emmanuel J
AU  - Favaloro EJ
AD  - a Department of Haematology, Institute of Clinical Pathology and Medical 
      Research, NSW Health Pathology , Westmead Hospital , Westmead , Australia.
AD  - b Sydney Centres for Thrombosis and Haemostasis , Westmead , Australia.
FAU - Pasalic, Leonardo
AU  - Pasalic L
AD  - a Department of Haematology, Institute of Clinical Pathology and Medical 
      Research, NSW Health Pathology , Westmead Hospital , Westmead , Australia.
AD  - b Sydney Centres for Thrombosis and Haemostasis , Westmead , Australia.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - England
TA  - Expert Rev Hematol
JT  - Expert review of hematology
JID - 101485942
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/chemistry/pharmacology/*therapeutic use
MH  - Clinical Trials as Topic
MH  - Drug Monitoring
MH  - Factor Xa Inhibitors/therapeutic use
MH  - Heparin/chemistry/pharmacology/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/chemistry/pharmacology/therapeutic use
MH  - Humans
MH  - Partial Thromboplastin Time
MH  - Thromboembolism/blood/drug therapy
MH  - Treatment Outcome
MH  - Venous Thromboembolism/blood/drug therapy
OTO - NOTNLM
OT  - APTT
OT  - Unfractionated heparin
OT  - activated partial thromboplastin time
OT  - anti-FXa assay
OT  - low molecular weight heparin
OT  - therapeutic range
EDAT- 2017/06/21 06:00
MHDA- 2017/10/11 06:00
CRDT- 2017/06/21 06:00
PHST- 2017/06/21 06:00 [pubmed]
PHST- 2017/10/11 06:00 [medline]
PHST- 2017/06/21 06:00 [entrez]
AID - 10.1080/17474086.2017.1345306 [doi]
PST - ppublish
SO  - Expert Rev Hematol. 2017 Jul;10(7):595-605. doi: 10.1080/17474086.2017.1345306.