PMID- 37321244
OWN - NLM
STAT- MEDLINE
DCOM- 20231201
LR  - 20231201
IS  - 2567-689X (Electronic)
IS  - 0340-6245 (Linking)
VI  - 123
IP  - 12
DP  - 2023 Dec
TI  - Factors Influencing Anti-Xa Assays: A Multicenter Prospective Study in Critically 
      Ill and Noncritically Ill Patients Receiving Unfractionated Heparin.
PG  - 1105-1115
LID - 10.1055/s-0043-1770096 [doi]
AB  - BACKGROUND:  The presence of dextran sulfate (DS) in reagents and the type of 
      blood collection tube (citrate/citrated-theophylline-adenosine-dipyridamole 
      [CTAD]) can lead to discrepancies between unfractionated heparin (UFH) anti-Xa 
      levels. OBJECTIVES:  To evaluate the extent of the effect (1) of different 
      reagents containing or not containing DS and (2) of the blood collection tubes, 
      on UFH anti-Xa levels, in various clinical situations (NCT04700670). METHODS:  We 
      prospectively included patients from eight centers: group (G)1, cardiopulmonary 
      bypass (CPB) after heparin neutralization (n = 39); G2, cardiothoracic intensive 
      care unit (ICU) after CPB (n = 35); G3, medical ICU (n = 53); G4, other medical 
      inpatients (n = 38). Blood was collected into citrated and CTAD tubes. 
      Chromogenic anti-Xa assays were centrally performed, using seven reagent/analyzer 
      combinations including two without DS. The association between anti-Xa levels and 
      covariates was tested using a linear mixed-effects model. RESULTS:  We analyzed 
      4,546 anti-Xa values from 165 patients. Median anti-Xa levels were systematically 
      higher with reagents containing DS, whatever the patient group, with the greatest 
      effect observed in G1 (0.32 vs. 0.05 IU/mL). Anti-Xa levels were slightly higher 
      in CTAD than in citrate samples, irrespective of the assay. The model showed: (1) 
      a significant dextran-patient group interaction (p < 0.0001), the effect of DS on 
      anti-Xa levels varying from 30.9% in G4 to 296% in G1, and (2) a significant 
      effect of CTAD, varying between patient groups (p = 0.0302). CONCLUSION:  The 
      variability of anti-Xa levels with a great overestimation of the values, using a 
      reagent containing DS, can lead to different treatment decisions, especially 
      after heparin neutralization by protamine. Clinical consequences of these 
      differences remain to be demonstrated.
CI  - Thieme. All rights reserved.
FAU - Lasne, Dominique
AU  - Lasne D
AUID- ORCID: 0000-0001-6600-0263
AD  - AP-HP, Laboratoire d'hematologie generale, Hopital Necker, INSERM, Univ. 
      Paris-Saclay, Le Kremlin-Bicetre, France.
FAU - Toussaint-Hacquard, Marie
AU  - Toussaint-Hacquard M
AD  - Hematologie Biologique, CHRU Nancy, Nancy, France.
FAU - Delassasseigne, Celine
AU  - Delassasseigne C
AD  - Laboratoire Hematologie, Hopital Haut-Leveque, CHU Bordeaux, France.
FAU - Bauters, Anne
AU  - Bauters A
AD  - CHU Lille, Institut d'Hematologie-Transfusion, Lille, France.
FAU - Flaujac, Claire
AU  - Flaujac C
AD  - Laboratoire de Biologie Medicale (Secteur Hemostase), Centre Hospitalier de 
      Versailles, Andre Mignot, Le Chesnay, France.
FAU - Savard, Philippe
AU  - Savard P
AD  - Hematologie Biologique, CHU Dijon Bourgogne, Dijon, France.
FAU - Mouton, Christine
AU  - Mouton C
AD  - Laboratoire Hematologie, Hopital Haut-Leveque, CHU Bordeaux, France.
FAU - De Maistre, Emmanuel
AU  - De Maistre E
AD  - Hematologie Biologique, CHU Dijon Bourgogne, Dijon, France.
FAU - Stepanian, Alain
AU  - Stepanian A
AD  - AP-HP, Service d'Hematologie Biologique, Hopital Lariboisiere, Paris Cite 
      University, Paris, France.
FAU - Eschwege, Valerie
AU  - Eschwege V
AD  - Hematologie Biologique, CHRU Nancy, Nancy, France.
FAU - Delrue, Maxime
AU  - Delrue M
AD  - AP-HP, Service d'Hematologie Biologique, Hopital Lariboisiere, Paris Cite 
      University, Paris, France.
FAU - Georges, Jean-Louis
AU  - Georges JL
AD  - Service de reanimation medico-chirurgicale, Centre Hospitalier de Versailles, 
      Andre Mignot, Le Chesnay, France.
FAU - Gros, Antoine
AU  - Gros A
AD  - Service de reanimation medico-chirurgicale, Centre Hospitalier de Versailles, 
      Andre Mignot, Le Chesnay, France.
FAU - Mansour, Alexandre
AU  - Mansour A
AD  - Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of 
      Rennes; Univ Rennes, CHU Rennes, Inserm, IRSET, Rennes, France.
FAU - Leroy, Guillaume
AU  - Leroy G
AD  - CHU Lille, Pole d'anesthesie-Reanimation, Lille, France.
FAU - Jouffroy, Romain
AU  - Jouffroy R
AD  - AP-HP, Service de reanimation adulte, Hopital Necker, Paris, France.
FAU - Mattei, Matthieu
AU  - Mattei M
AD  - Unite d'Anesthesie et Reanimation Cardiaque & Reanimation Medicale Brabois, CHRU 
      Nancy, Nancy, France.
FAU - Beurton, Antoine
AU  - Beurton A
AD  - Department of Cardiovascular Anaesthesia and Critical care, Surgical Medical 
      Center Magellan, Haut-Leveque Hospital, Pessac, France.
FAU - Pontis, Adeline
AU  - Pontis A
AD  - Hematologie Biologique, Hopital Pontchaillou, University Hospital of Rennes, 
      Univ. Rennes, CHU Rennes, Inserm, IRSET, Rennes, France.
FAU - Neuwirth, Marie
AU  - Neuwirth M
AD  - AP-HP, Service d'Hematologie Biologique, Hopital Lariboisiere, Paris Cite 
      University, Paris, France.
FAU - Nedelec-Gac, Fabienne
AU  - Nedelec-Gac F
AD  - Hematologie Biologique, Hopital Pontchaillou, University Hospital of Rennes, 
      Univ. Rennes, CHU Rennes, Inserm, IRSET, Rennes, France.
FAU - Lecompte, Thomas
AU  - Lecompte T
AD  - Department of Pharmacy, Faculte de medecine, Namur Thrombosis and Hemostasis 
      Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Universite 
      de Lorraine & Universite de Namur, Namur, Belgium.
AD  - Hematologie Biologique, Hopital Pontchaillou University Hospital of Rennes, 
      Rennes, France.
FAU - Curis, Emmanuel
AU  - Curis E
AD  - UR 7537 BioSTM, faculte de pharmacie de Paris, universite Paris Cite, Paris, 
      France.
AD  - Service d'Hematologie Biologique, Hopital Lariboisiere, AP-HP, Paris, France.
FAU - Siguret, Virginie
AU  - Siguret V
AD  - AP-HP, Service d'Hematologie Biologique, Hopital Lariboisiere, Paris Cite 
      University, Paris, France.
FAU - Gouin-Thibault, Isabelle
AU  - Gouin-Thibault I
AD  - Hematologie Biologique, Hopital Pontchaillou, University Hospital of Rennes, 
      Univ. Rennes, CHU Rennes, Inserm, IRSET, Rennes, France.
LA  - eng
SI  - ClinicalTrials.gov/NCT04700670
PT  - Journal Article
PT  - Multicenter Study
DEP - 20230615
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 2968PHW8QP (Citric Acid)
RN  - 0 (Citrates)
RN  - 0 (Factor Xa Inhibitors)
SB  - IM
MH  - Humans
MH  - *Heparin/adverse effects
MH  - *Anticoagulants/therapeutic use
MH  - Prospective Studies
MH  - Critical Illness
MH  - Heparin, Low-Molecular-Weight
MH  - Citric Acid
MH  - Citrates/therapeutic use
MH  - Factor Xa Inhibitors
MH  - Partial Thromboplastin Time
COIS- None declared.
EDAT- 2023/06/16 01:08
MHDA- 2023/12/01 06:44
CRDT- 2023/06/15 18:53
PHST- 2023/12/01 06:44 [medline]
PHST- 2023/06/16 01:08 [pubmed]
PHST- 2023/06/15 18:53 [entrez]
AID - 10.1055/s-0043-1770096 [doi]
PST - ppublish
SO  - Thromb Haemost. 2023 Dec;123(12):1105-1115. doi: 10.1055/s-0043-1770096. Epub 
      2023 Jun 15.