PMID- 31837560
OWN - NLM
STAT- MEDLINE
DCOM- 20210617
LR  - 20210617
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 186
DP  - 2020 Feb
TI  - Monitoring unfractionated heparin therapy. 4 hour-stability of anti-Xa activity 
      in unspun citrated tubes.
PG  - 7-12
LID - S0049-3848(19)30464-5 [pii]
LID - 10.1016/j.thromres.2019.10.019 [doi]
AB  - Current guidelines recommend performing laboratory tests aimed at monitoring 
      unfractionated heparin (UFH) treatments within a delay not exceeding 1 to 2 h(s) 
      after sampling when blood is collected into citrated tubes. As such a short delay 
      could be an issue, we evaluated the potential impact of longer delays. For that 
      purpose, two citrated tubes were obtained from patients on UFH: one was 
      centrifuged and tested for anti-Xa activity and aPTT within 1 h after collection 
      (T1 h) and one was stored for 4 h at room temperature (T4 h) before being 
      processed. A total of 123 paired tubes were investigated. Anti-Xa activity was 
      significantly lower at T4 h than at T1 h, with a mean bias, calculated according 
      to Bland-Altman, of 0.05 IU/mL. Considering 0.30 to 0.70 IU/mL as the therapeutic 
      range, there were 12 cases of discrepant test results (9.8%). Most of them being 
      around the lower limit of the therapeutic range had no impact on patients' 
      management. APTT was significantly shortened (p < 0.0001) at T4 h vs. T1 h, with 
      a mean bias of -7.9 s. Considering anti-Xa correlated aPTT therapeutic range, 29 
      cases of discrepant test results (23.6%) were found, 10% would have induce dosage 
      changes. The concordance between anti-Xa activities measured at T4 h and T1 h was 
      excellent (kappa = 0.813) and good for aPTT (kappa = 0.661). In conclusion, 
      extending the delay between blood collection and measurement of tests prescribed 
      for monitoring UFH therapy up to 4 h was found to lead to a systematic reduction 
      in both anti-Xa activity and aPTT in unspun citrated tubes. As changes at T4 h 
      were limited and had few clinically relevance than the ones observed with aPTT 
      testing, a 4 h-delay was found to be acceptable for anti-Xa activity. The maximum 
      delay for aPTT should remain around 1-2 h as changes were more relevant.
CI  - Copyright (c) 2019. Published by Elsevier Ltd.
FAU - Toulon, Pierre
AU  - Toulon P
AD  - Universite Cote d'Azur, CHU Nice, Hematology Department, Nice, France. Electronic 
      address: toulon.p@chu-nice.fr.
FAU - Appert-Flory, Anny
AU  - Appert-Flory A
AD  - Universite Cote d'Azur, CHU Nice, Hematology Department, Nice, France.
FAU - Fischer, Florence
AU  - Fischer F
AD  - Universite Cote d'Azur, CHU Nice, Hematology Department, Nice, France.
FAU - Buvat, Sylvain
AU  - Buvat S
AD  - Universite Cote d'Azur, CHU Nice, Hematology Department, Nice, France.
FAU - Jambou, Didier
AU  - Jambou D
AD  - Universite Cote d'Azur, CHU Nice, Hematology Department, Nice, France.
FAU - Mahagne, Marie-Helene
AU  - Mahagne MH
AD  - Universite Cote d'Azur, CHU Nice, Neurology Department, Nice, France.
LA  - eng
PT  - Journal Article
DEP - 20191024
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - *Drug Monitoring
MH  - Factor Xa Inhibitors/therapeutic use
MH  - *Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight
MH  - Humans
MH  - Partial Thromboplastin Time
OTO - NOTNLM
OT  - Anti-Xa activity
OT  - Monitoring
OT  - Stability
OT  - Unfractionated heparin
OT  - aPTT
EDAT- 2019/12/15 06:00
MHDA- 2021/06/22 06:00
CRDT- 2019/12/15 06:00
PHST- 2019/05/31 00:00 [received]
PHST- 2019/10/18 00:00 [revised]
PHST- 2019/10/19 00:00 [accepted]
PHST- 2019/12/15 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2019/12/15 06:00 [entrez]
AID - S0049-3848(19)30464-5 [pii]
AID - 10.1016/j.thromres.2019.10.019 [doi]
PST - ppublish
SO  - Thromb Res. 2020 Feb;186:7-12. doi: 10.1016/j.thromres.2019.10.019. Epub 2019 Oct 
      24.