PMID- 35499336
OWN - NLM
STAT- MEDLINE
DCOM- 20221004
LR  - 20221222
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 56
IP  - 12
DP  - 2022 Dec
TI  - Comparison of Managing Factor Xa Inhibitor to Unfractionated Heparin Transitions 
      by aPTT Versus a Treatment Guideline Utilizing Heparin Anti-Xa Levels.
PG  - 1289-1298
LID - 10.1177/10600280221090211 [doi]
AB  - BACKGROUND: There are inadequate data on the optimal strategy for transitioning 
      factor Xa inhibitors (FXai; apixaban, rivaroxaban) to unfractionated heparin 
      (UFH) infusions. OBJECTIVE: In patients transitioning from an FXai to an UFH 
      infusion, this study compared the safety and efficacy of monitoring UFH infusions 
      using an activated partial thromboplastin time (aPTT) titration scale versus 
      utilizing an UFH-calibrated anti-Xa titration scale aided by a novel 
      institutional guideline. METHODS: A retrospective cohort analysis was conducted 
      on adult patients transitioning from an FXai to an UFH infusion at 2 medical 
      centers from June 1, 2018, to November 1, 2020. One institution utilized aPTT 
      while the other institution primarily used UFH-calibrated anti-Xa. The primary 
      endpoint was a composite of death, major bleeding, or new thrombosis during the 
      hospitalization with a planned noninferiority analysis. Secondary outcomes were 
      also collected including the amount and duration of UFH administered between 
      cohorts. RESULTS: The incidence rate of the primary composite endpoint was 6.3% 
      in the anti-Xa group and 11% in the aPTT group (P < 0.001 for noninferiority, P = 
      0.138 for superiority) meeting noninferiority criteria. No statistical 
      differences were seen in new thrombosis, major bleeding, or any bleeding. 
      CONCLUSION AND RELEVANCE: This represents the first report of a comparison 
      between aPTT versus anti-Xa monitoring in relation to clinical outcomes for 
      patients transitioning from an FXai to an UFH infusion. A transition guideline 
      primarily utilizing an UFH-calibrated anti-Xa assay appears to be a safe 
      alternative to aPTT monitoring and can aid facilities in the management of 
      patients during these complex transitions.
FAU - Dingus, Scott J
AU  - Dingus SJ
AD  - Department of Pharmacy, Platte Health Center Avera, Platte, SD, USA.
FAU - Smith, Alex R
AU  - Smith AR
AD  - Department of Pharmaceutical Services, Sanford USD Medical Center, Sioux Falls, 
      SD, USA.
FAU - Dager, William E
AU  - Dager WE
AD  - Department of Pharmacy, UC Davis Medical Center, Sacramento, CA, USA.
FAU - Zochert, Sara
AU  - Zochert S
AD  - Department of Pharmaceutical Services, Sanford USD Medical Center, Sioux Falls, 
      SD, USA.
FAU - Nothdurft, Salli A
AU  - Nothdurft SA
AD  - Department of Pharmaceutical Services, Sanford USD Medical Center, Sioux Falls, 
      SD, USA.
FAU - Gulseth, Michael P
AU  - Gulseth MP
AUID- ORCID: 0000-0002-4522-0985
AD  - Department of Pharmaceutical Services, Sanford USD Medical Center, Sioux Falls, 
      SD, USA.
AD  - Department of Internal Medicine, Sanford School of Medicine, University of South 
      Dakota, Sioux Falls, SD, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20220502
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Adult
MH  - Anticoagulants/adverse effects
MH  - Drug Monitoring
MH  - Factor Xa
MH  - *Factor Xa Inhibitors/adverse effects
MH  - Fibrinolytic Agents/therapeutic use
MH  - Hemorrhage/chemically induced/drug therapy
MH  - *Heparin/adverse effects
MH  - Heparin, Low-Molecular-Weight
MH  - Humans
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
MH  - Rivaroxaban/adverse effects
OTO - NOTNLM
OT  - Xa level
OT  - activated partial thromboplastin time
OT  - anti-Xa assay
OT  - anticoagulant
OT  - anticoagulation
OT  - anticoagulation bridging
OT  - apixaban
OT  - conversions
OT  - direct oral anticoagulant
OT  - factor Xa inhibitor
OT  - heparin
OT  - rivaroxaban
OT  - transitions
OT  - unfractionated heparin
EDAT- 2022/05/03 06:00
MHDA- 2022/10/05 06:00
CRDT- 2022/05/02 09:03
PHST- 2022/05/03 06:00 [pubmed]
PHST- 2022/10/05 06:00 [medline]
PHST- 2022/05/02 09:03 [entrez]
AID - 10.1177/10600280221090211 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2022 Dec;56(12):1289-1298. doi: 10.1177/10600280221090211. Epub 
      2022 May 2.