PMID- 32964730
OWN - NLM
STAT- MEDLINE
DCOM- 20210524
LR  - 20210524
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 55
IP  - 5
DP  - 2021 May
TI  - Effectiveness of a Calculation-Free Weight-Based Unfractionated Heparin Nomogram 
      With Anti-Xa Level Monitoring Compared With Activated Partial Thromboplastin 
      Time.
PG  - 575-583
LID - 10.1177/1060028020961503 [doi]
AB  - BACKGROUND: Accurate monitoring of intravenous unfractionated heparin (UFH) is 
      essential to mitigate the risk of adverse drug events associated with dosing 
      errors. Although recent data support anti-factor Xa (anti-Xa) monitoring 
      preferentially over activated partial thromboplastin time (aPTT) to improve time 
      to therapeutic anticoagulation, the utility of incorporating anti-Xa monitoring 
      with a calculation-free weight-based UFH nomogram has not been formally 
      evaluated. OBJECTIVE: The primary objective of this study was to evaluate the 
      time to therapeutic anticoagulation of a calculation-free weight-based UFH 
      nomogram integrated with anti-Xa monitoring versus a historical control of aPTT 
      monitoring utilizing manual dose calculations. METHODS: This was a retrospective 
      analysis of patients with anti-Xa monitoring and a novel calculation-free 
      weight-based UFH nomogram compared with a historical control with aPTT monitoring 
      and manual calculations. RESULTS: A total of 103 patients in the aPTT cohort and 
      100 patients in the anti-Xa cohort were analyzed. The anti-Xa cohort achieved 
      goal therapeutic target 3.8 hours sooner than the aPTT cohort (P = 0.03). 
      Patients with anti-Xa monitoring required 1 fewer adjustment per 2.5 patient-days 
      of UFH with the venous thromboembolism nomogram (P = 0.02). Patients in the aPTT 
      cohort required more infusion interruptions because of supratherapeutic values (P 
      = 0.007) and boluses because of subtherapeutic values (P = 0.044). There were no 
      differences in rates of thromboembolism, major bleeding, or clinically relevant 
      nonmajor bleeding between the cohorts. CONCLUSION AND RELEVANCE: This study 
      demonstrated that anti-Xa UFH monitoring integrated with a calculation-free 
      nomogram results in faster time to therapeutic anticoagulation and fewer dose 
      adjustments compared with aPTT monitoring with manual calculations.
FAU - Kindelin, Nicole M
AU  - Kindelin NM
AUID- ORCID: 0000-0002-1503-5762
AD  - VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
FAU - Anthes, Ananth M
AU  - Anthes AM
AUID- ORCID: 0000-0002-4461-9185
AD  - VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
FAU - Providence, Sarah M
AU  - Providence SM
AD  - VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
FAU - Zhao, Xinhua
AU  - Zhao X
AD  - VA Center for Health Equity Research and Promotion, Pittsburgh, PA, USA.
FAU - Aspinall, Sherrie L
AU  - Aspinall SL
AD  - VA Center for Health Equity Research and Promotion, Pittsburgh, PA, USA.
AD  - VA Center for Medication Safety, Hines, IL, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20200923
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Blood Coagulation/drug effects/physiology
MH  - Cohort Studies
MH  - Drug Monitoring/*methods/standards
MH  - Factor Xa Inhibitors/*administration & dosage/adverse effects
MH  - Hemorrhage/blood/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Nomograms
MH  - Partial Thromboplastin Time/methods/standards
MH  - Retrospective Studies
MH  - Thromboembolism/blood/drug therapy
OTO - NOTNLM
OT  - anti-factor Xa
OT  - anticoagulants
OT  - dose-response relationship
OT  - unfractionated heparin
EDAT- 2020/09/24 06:00
MHDA- 2021/05/25 06:00
CRDT- 2020/09/23 08:38
PHST- 2020/09/24 06:00 [pubmed]
PHST- 2021/05/25 06:00 [medline]
PHST- 2020/09/23 08:38 [entrez]
AID - 10.1177/1060028020961503 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2021 May;55(5):575-583. doi: 10.1177/1060028020961503. Epub 
      2020 Sep 23.