PMID- 36232517
OWN - NLM
STAT- MEDLINE
DCOM- 20221017
LR  - 20230308
IS  - 1422-0067 (Electronic)
IS  - 1422-0067 (Linking)
VI  - 23
IP  - 19
DP  - 2022 Sep 23
TI  - Anticoagulation Monitoring with Activated Partial ThromboPlastin Time and Anti-Xa 
      Activity in Intensive Care Unit Patients: Interest of Thrombin Generation Assay.
LID - 10.3390/ijms231911219 [doi]
LID - 11219
AB  - Current guidelines recommend monitoring the anticoagulant effect of 
      unfractionated heparin (UFH) by measuring anti-Xa activity rather than activated 
      partial thromboplastin time (aPTT) in intensive care unit (ICU) patients. The 
      primary objective of this study was to evaluate the correlation of aPTT, anti-Xa 
      activity, and thrombin generation in UFH-treated ICU patients. A prospective 
      observational pilot study was conducted in adult surgical ICU patients treated 
      with UFH. aPTT and anti-Xa activity were monitored daily. The therapeutic target 
      was aPTT between 50 s and 84 s, and/or anti-Xa between 0.3 and 0.7 U/mL. 
      Correlation among aPTT, anti-Xa activity, and thrombin generation was determined 
      by measuring endogenous thrombin potential (ETP), with the inflammatory response 
      evaluated. C-reactive protein (CRP) was used as a marker of inflammatory 
      response. The plasma of 107 samples from 30 ICU patients was analyzed. The 
      correlation between aPTT and anti-Xa activity was 0.66, CI95% [0.54;0.76] (p < 
      0.0001). Although thrombin generation, aPTT, and anti-Xa were correlated with 
      inflammatory responses, the correlation was higher with thrombin generation and 
      anti-Xa activity compared to aPTT. When aPTT was in a therapeutic range, a low 
      thrombin generation was observed but was 50% inhibited when anti-Xa was in a 
      therapeutic range. Coagulation testing with aPTT, anti-Xa correlated with 
      thrombin generation. A 50% decrease in thrombin generation was observed when 
      anti-Xa was within a therapeutic range. Further work is needed to evaluate 
      coagulation biomarker responses and clinical outcomes in specific ICU 
      populations.
FAU - Billoir, Paul
AU  - Billoir P
AUID- ORCID: 0000-0001-5632-7713
AD  - Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Vascular 
      Hemostasis Unit, F 76000 Rouen, France.
FAU - Elie, Thomas
AU  - Elie T
AD  - Department of Anesthesiology and Critical Care, Rouen University Hospital, F 
      76000 Rouen, France.
FAU - Levy, Jerrold H
AU  - Levy JH
AUID- ORCID: 0000-0003-3766-4962
AD  - Departments of Anesthesiology, Critical Care, and Surgery (Cardiothoracic), Duke 
      University School of Medicine, Durham, NC 27710, USA.
FAU - Besnier, Emmanuel
AU  - Besnier E
AD  - Department of Anesthesiology and Critical Care, Rouen University Hospital, 
      Normandie Univ, UNIROUEN, INSERM U1096, F 76000 Rouen, France.
FAU - Dureuil, Bertrand
AU  - Dureuil B
AD  - Department of Anesthesiology and Critical Care, Rouen University Hospital, F 
      76000 Rouen, France.
FAU - Veber, Benoit
AU  - Veber B
AD  - Department of Anesthesiology and Critical Care, Rouen University Hospital, F 
      76000 Rouen, France.
FAU - Le Cam-Duchez, Veronique
AU  - Le Cam-Duchez V
AD  - Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Vascular 
      Hemostasis Unit, F 76000 Rouen, France.
FAU - Clavier, Thomas
AU  - Clavier T
AD  - Department of Anesthesiology and Critical Care, Rouen University Hospital, F 
      76000 Rouen, France.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20220923
PL  - Switzerland
TA  - Int J Mol Sci
JT  - International journal of molecular sciences
JID - 101092791
RN  - 0 (Anticoagulants)
RN  - 0 (Biomarkers)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - 9007-41-4 (C-Reactive Protein)
RN  - EC 3.4.21.5 (Thrombin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/pharmacology/therapeutic use
MH  - Biomarkers
MH  - C-Reactive Protein
MH  - Drug Monitoring
MH  - Factor Xa Inhibitors/pharmacology/therapeutic use
MH  - *Heparin/pharmacology
MH  - Heparin, Low-Molecular-Weight
MH  - Humans
MH  - Intensive Care Units
MH  - Partial Thromboplastin Time
MH  - Prospective Studies
MH  - *Thrombin
PMC - PMC9570449
OTO - NOTNLM
OT  - activated partial thromboplastin time
OT  - coagulation tests
OT  - factor Xa
OT  - heparin
OT  - inflammation
OT  - intensive care unit
OT  - thrombin generation
COIS- The authors declare no conflict of interest.
EDAT- 2022/10/15 06:00
MHDA- 2022/10/18 06:00
PMCR- 2022/09/23
CRDT- 2022/10/14 02:07
PHST- 2022/08/29 00:00 [received]
PHST- 2022/09/20 00:00 [revised]
PHST- 2022/09/22 00:00 [accepted]
PHST- 2022/10/14 02:07 [entrez]
PHST- 2022/10/15 06:00 [pubmed]
PHST- 2022/10/18 06:00 [medline]
PHST- 2022/09/23 00:00 [pmc-release]
AID - ijms231911219 [pii]
AID - ijms-23-11219 [pii]
AID - 10.3390/ijms231911219 [doi]
PST - epublish
SO  - Int J Mol Sci. 2022 Sep 23;23(19):11219. doi: 10.3390/ijms231911219.