PMID- 30213200
OWN - NLM
STAT- MEDLINE
DCOM- 20200611
LR  - 20210109
IS  - 1938-2723 (Electronic)
IS  - 1076-0296 (Print)
IS  - 1076-0296 (Linking)
VI  - 24
IP  - 9_suppl
DP  - 2018 Dec
TI  - Time in the Therapeutic Range for Assessing Anticoagulation Quality in Patients 
      Receiving Continuous Unfractionated Heparin.
PG  - 178S-181S
LID - 10.1177/1076029618798944 [doi]
AB  - Due to variable pharmacokinetic properties, therapeutic anticoagulation with 
      continuous unfractionated heparin (UFH) requires ongoing laboratory monitoring, 
      generally with activated partial thromboplastin time (aPTT). In the ambulatory 
      setting, clinicians who manage warfarin therapy often use time in the therapeutic 
      range (TTR) to estimate a percentage of time the international normalized ratio 
      is therapeutic. We applied the TTR concept to aPTT monitoring for therapeutic UFH 
      and used 2 methodologies for estimation: percentage of aPTT values in range 
      (%aIR) and a modification of the Rosendaal method (mod-Rosendaal). This study 
      included adult inpatients admitted between September 30, 2015, and September 30, 
      2016, at Brigham and Women's Hospital. For each patient, all available aPTT 
      values were extracted to calculate 2 individual TTRs according to each 
      methodology. Comparison between methods was performed using Student t test, and 
      correlation was assessed with simple linear regression. A total of 255 patients 
      were included in this study. The major outcome of TTR estimation was 
      significantly higher using mod-Rosendaal (43.7% [26.5%]) versus %aIR (37.7% 
      [25.7%], P = .012) by a mean difference of 6% points (95% confidence interval: 
      1.3-10.7). Time in the therapeutic range estimated by mod-Rosendaal significantly 
      correlated with those estimated by %aIR (r = 0.84, P < .001). Further studies 
      should evaluate the correlation between TTR and clinical outcomes and establish a 
      benchmark for quality therapeutic anticoagulation with continuous UFH.
FAU - Ting, Clara
AU  - Ting C
AUID- ORCID: 0000-0003-0376-6717
AD  - Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
FAU - Sylvester, Katelyn W
AU  - Sylvester KW
AD  - Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
FAU - Schurr, James W
AU  - Schurr JW
AUID- ORCID: 0000-0001-5330-4604
AD  - School of Medicine, Stony Brook University, Stony Brook, NY, USA.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20180913
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  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*administration & dosage/*pharmacokinetics
MH  - *Drug Monitoring
MH  - Female
MH  - Heparin/*administration & dosage/*pharmacokinetics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
PMC - PMC6714859
OTO - NOTNLM
OT  - anticoagulation
OT  - heparin
OT  - partial thromboplastin time
COIS- Declaration of Conflicting Interests: The author(s) declared the following 
      potential conflicts of interest with respect to the research, authorship, and/or 
      publication of this article: Katelyn W. Sylvester has participated on a 
      scientific advisory board for Bristol Meyers Squibb/Pfizer.
EDAT- 2018/09/15 06:00
MHDA- 2020/06/12 06:00
PMCR- 2018/09/13
CRDT- 2018/09/15 06:00
PHST- 2018/09/15 06:00 [pubmed]
PHST- 2020/06/12 06:00 [medline]
PHST- 2018/09/15 06:00 [entrez]
PHST- 2018/09/13 00:00 [pmc-release]
AID - 10.1177_1076029618798944 [pii]
AID - 10.1177/1076029618798944 [doi]
PST - ppublish
SO  - Clin Appl Thromb Hemost. 2018 Dec;24(9_suppl):178S-181S. doi: 
      10.1177/1076029618798944. Epub 2018 Sep 13.