PMID- 29886450
OWN - NLM
STAT- MEDLINE
DCOM- 20191017
LR  - 20191210
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 8
IP  - 6
DP  - 2018 Jun 9
TI  - Accuracy, reproducibility and costs of different laboratory assays for the 
      monitoring of unfractionated heparin in clinical practice: a prospective 
      evaluation study and survey among Swiss institutions.
PG  - e022943
LID - 10.1136/bmjopen-2018-022943 [doi]
LID - e022943
AB  - OBJECTIVES: To investigate the accuracy, reproducibility and costs of different 
      laboratory assays for the monitoring of unfractionated heparin (UFH) in clinical 
      practice and to study test utilisation in Switzerland. DESIGN: Prospective 
      evaluation study and survey among Swiss hospitals and laboratories. SETTING: 
      Secondary care hospital in rural Switzerland (evaluation study); all Swiss 
      hospitals and laboratories (survey). PARTICIPANTS: All consecutive patients, 
      monitored for treatment with UFH during two time periods, were included (May to 
      July 2014 and January to February 2015; n=254). OUTCOME MEASURES: Results of 
      activated partial thromboplastin time (aPTT), thrombin time (TT), 
      prothrombinase-induced clotting time (PiCT) and anti-Xa activity with respect to 
      UFH concentration RESULTS: Spearman's correlation coefficient (r(s)) with regard 
      to anti-Xa activity was 0.68 (95% CI 0.60 to 0.75) for aPTT, 0.79 (0.69 to 0.86) 
      for TT and 0.94 (0.93 to 0.95) for PiCT. The correlation (r(s)) between anti-Xa 
      activity and heparin concentration as determined by spiking plasma samples was 
      1.0 (1.0 to 1.0). The coefficient of variation was at most 5% for PiCT and 
      anti-Xa activity (within-run as well as day-to-day variability). The total costs 
      per test in Swiss Francs (SFr) were SFr23.40 for aPTT, SFr33.30 for TT, SFr15.70 
      for PiCT and SFr24.15 for anti-Xa activity. The various tests were employed in 
      Swiss institutions with the following frequencies: aPTT 53.2%, TT 21.6%, anti-Xa 
      activity 7.2%, PiCT 1.4%; 16.6% of hospitals performed more than one test. 
      CONCLUSIONS: The accuracy and reproducibility of PiCT and anti-Xa activity for 
      monitoring of UFH was superior, and analytical costs were equivalent to or lower 
      than aPTT and TT.
CI  - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of 
      the article) 2018. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - Burki, Susanne
AU  - Burki S
AD  - Department of Haematology, Inselspital, Bern University Hospital, University of 
      Bern, Bern, Switzerland.
FAU - Brand, Beatrice
AU  - Brand B
AD  - Department of Medicine, Spital Emmental, Burgdorf, Switzerland.
FAU - Escher, Robert
AU  - Escher R
AD  - Department of Medicine, Spital Emmental, Burgdorf, Switzerland.
FAU - Wuillemin, Walter A
AU  - Wuillemin WA
AD  - Division of Haematology and Central Haematology Laboratory, Luzerner 
      Kantonsspital, Lucerne, Switzerland.
FAU - Nagler, Michael
AU  - Nagler M
AUID- ORCID: 0000-0003-4319-2367
AD  - Department of Haematology, Inselspital, Bern University Hospital, University of 
      Bern, Bern, Switzerland.
AD  - Department for BioMedical Research, University of Bern, Bern, Switzerland.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180609
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Blood Coagulation Tests/*economics/*standards
MH  - Costs and Cost Analysis
MH  - Drug Monitoring/*methods
MH  - Heparin/*blood
MH  - Humans
MH  - Linear Models
MH  - Prospective Studies
MH  - Reproducibility of Results
MH  - Surveys and Questionnaires
MH  - Switzerland
MH  - Time Factors
PMC - PMC6009553
OTO - NOTNLM
OT  - drug monitoring
OT  - health care costs
OT  - heparin/therapy
OT  - partial thromboplastin time
OT  - thrombin time
COIS- Competing interests: MN has received research grants or lecture fees from Bayer, 
      Axonlab and Roche Diagnostics.
EDAT- 2018/06/11 06:00
MHDA- 2019/10/18 06:00
PMCR- 2018/06/09
CRDT- 2018/06/11 06:00
PHST- 2018/06/11 06:00 [entrez]
PHST- 2018/06/11 06:00 [pubmed]
PHST- 2019/10/18 06:00 [medline]
PHST- 2018/06/09 00:00 [pmc-release]
AID - bmjopen-2018-022943 [pii]
AID - 10.1136/bmjopen-2018-022943 [doi]
PST - epublish
SO  - BMJ Open. 2018 Jun 9;8(6):e022943. doi: 10.1136/bmjopen-2018-022943.