PMID- 28759760
OWN - NLM
STAT- MEDLINE
DCOM- 20180514
LR  - 20180514
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 157
DP  - 2017 Sep
TI  - Should we abandon the APTT for monitoring unfractionated heparin?
PG  - 157-161
LID - S0049-3848(17)30408-5 [pii]
LID - 10.1016/j.thromres.2017.07.006 [doi]
AB  - INTRODUCTION: The activated partial thromboplastin time (APTT) is commonly used 
      to monitor unfractionated heparin (UFH) but may not accurately measure the amount 
      of heparin present. The anti-Xa assay is less susceptible to confounding factors 
      and may be a better assay for this purpose. MATERIALS AND METHODS: The validity 
      of the APTT for monitoring UFH was assessed by comparing with an anti-Xa assay on 
      3543 samples from 475 patients (infants [n=165], children 1-15years [n=60] and 
      adults [n=250]) receiving treatment dose UFH. RESULTS: Overall concordance was 
      poor. The highest concordance (66%; 168/254) was seen in children. Concordance 
      (51.8%) or discordance (48.4%) was almost equal in adult patients. Among adult 
      patients whose anti-Xa level was within 0.3-0.7IU/mL, only 38% had an APTT in the 
      therapeutic range whilst 56% were below and 6% were above therapeutic range. 
      Children and adult patients with anti-Xa of 0.3-0.7IU/mL but sub- therapeutic 
      APTT had significantly higher fibrinogen levels compared to those with 
      therapeutic or supra-therapeutic APTT. CONCLUSIONS: When the anti-Xa level was 
      0.3-0.7IU/mL, the majority of samples from infants demonstrated a 
      supra-therapeutic APTT, whilst adults tended to have a sub-therapeutic APTT. This 
      may lead to under anticoagulation in infants or over anticoagulation in adults 
      with risk of bleeding if APTT is used to monitor UFH. These results further 
      strengthen existing evidence of the limitation of APTT in monitoring UFH. 
      Discordance of APTT and anti-Xa level in adults and children may be due to 
      elevation of fibrinogen level.
CI  - Crown Copyright (c) 2017. Published by Elsevier Ltd. All rights reserved.
FAU - Arachchillage, D R J
AU  - Arachchillage DRJ
AD  - Department of Haematology, Royal Brompton & Harefield NHS Foundation Trust, 
      London, UK; Department of Haematology, Imperial College Healthcare NHS Trust and 
      Imperial College London, London, UK. Electronic address: 
      d.arachchillage@imperial.ac.uk.
FAU - Kamani, F
AU  - Kamani F
AD  - Department of Haematology, Royal Brompton & Harefield NHS Foundation Trust, 
      London, UK.
FAU - Deplano, S
AU  - Deplano S
AD  - Department of Haematology, Royal Brompton & Harefield NHS Foundation Trust, 
      London, UK.
FAU - Banya, W
AU  - Banya W
AD  - Department of Haematology, Royal Brompton & Harefield NHS Foundation Trust, 
      London, UK.
FAU - Laffan, M
AU  - Laffan M
AD  - Department of Haematology, Imperial College Healthcare NHS Trust and Imperial 
      College London, London, UK.
LA  - eng
PT  - Journal Article
DEP - 20170706
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Female
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Male
MH  - Partial Thromboplastin Time/*methods
OTO - NOTNLM
OT  - Activated partial thromboplastin time
OT  - Anti-Xa
OT  - Concordance
OT  - Fibrinogen
OT  - Heparin
EDAT- 2017/08/02 06:00
MHDA- 2018/05/15 06:00
CRDT- 2017/08/01 06:00
PHST- 2017/05/09 00:00 [received]
PHST- 2017/06/23 00:00 [revised]
PHST- 2017/07/05 00:00 [accepted]
PHST- 2017/08/02 06:00 [pubmed]
PHST- 2018/05/15 06:00 [medline]
PHST- 2017/08/01 06:00 [entrez]
AID - S0049-3848(17)30408-5 [pii]
AID - 10.1016/j.thromres.2017.07.006 [doi]
PST - ppublish
SO  - Thromb Res. 2017 Sep;157:157-161. doi: 10.1016/j.thromres.2017.07.006. Epub 2017 
      Jul 6.