PMID- 37989523
OWN - NLM
STAT- MEDLINE
DCOM- 20240320
LR  - 20240320
IS  - 1751-553X (Electronic)
IS  - 1751-5521 (Linking)
VI  - 46
IP  - 2
DP  - 2024 Apr
TI  - Anti-factor Xa as the preferred assay to monitor heparin for the treatment of 
      pulmonary embolism.
PG  - 354-361
LID - 10.1111/ijlh.14207 [doi]
AB  - INTRODUCTION: The mainstay of acute pulmonary embolism (PE) treatment is 
      anticoagulation. Timely anticoagulation correlates with decreased PE-associated 
      mortality, but the ability to achieve a therapeutic activated partial 
      thromboplastin time (aPTT) with unfractionated heparin (UFH) remains limited. 
      Although some institutions have switched to a more accurate and reproducible test 
      to assess for heparin's effectiveness, the anti-factor Xa (antiXa) assay, data 
      correlating a timely therapeutic antiXa to PE-associated clinical outcomes 
      remains scarce. We evaluated time to a therapeutic antiXa using intravenous 
      heparin after PE response team (PERT) activation and assessed clinical outcomes 
      including bleeding and recurrent thromboembolic events. METHODS: This was a 
      retrospective cohort study at NYU Langone Health. All adult patients >/=18 years 
      with a confirmed PE started on IV UFH with >2 antiXa levels were included. 
      Patients were excluded if they received thrombolysis or alternative 
      anticoagulation. The primary endpoint was the time to a therapeutic antiXa level 
      of 0.3-0.7 units/mL. Secondary outcomes included recurrent thromboembolism, 
      bleeding and PE-associated mortality within 3 months. RESULTS: A total of 330 
      patients with a PERT consult were identified with 192 patients included. The 
      majority of PEs were classified as sub massive (64.6%) with 87% of patients 
      receiving a bolus of 80 units/kg of UFH prior to starting an infusion at 18 
      units/kg/hour. The median time to the first therapeutic antiXa was 9.13 hours 
      with 93% of the cohort sustaining therapeutic anticoagulation at 48 hours. 
      Recurrent thromboembolism, bleeding and mortality occurred in 1%, 5% and 6.2%, 
      respectively. Upon univariate analysis, a first antiXa <0.3 units/ml was 
      associated with an increased risk of mortality [27.78% (5/18) vs 8.05% (14/174), 
      p = 0.021]. CONCLUSION: We observed a low incidence of recurrent thromboembolism 
      or PE-associated mortality utilizing an antiXa titrated UFH protocol. The use of 
      an antiXa based heparin assay to guide heparin dosing and monitoring allows for 
      timely and sustained therapeutic anticoagulation for treatment of PE.
CI  - (c) 2023 John Wiley & Sons Ltd.
FAU - Zhu, Eric
AU  - Zhu E
AD  - Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts, USA.
FAU - Yuriditsky, Eugene
AU  - Yuriditsky E
AD  - Department of Medicine, Division of Cardiology, NYU Grossman School of Medicine, 
      New York, New York, USA.
FAU - Raco, Veronica
AU  - Raco V
AD  - Department of Pharmacy, NYU Langone Brooklyn, Brooklyn, New York, USA.
FAU - Katz, Alyson
AU  - Katz A
AD  - Department of Pharmacy, NYU Langone Health, New York, New York, USA.
FAU - Papadopoulos, John
AU  - Papadopoulos J
AD  - Department of Pharmacy, NYU Langone Health, New York, New York, USA.
FAU - Horowitz, James
AU  - Horowitz J
AD  - Department of Medicine, Division of Cardiology, NYU Grossman School of Medicine, 
      New York, New York, USA.
FAU - Maldonado, Thomas
AU  - Maldonado T
AD  - Department of Surgery, Vascular, NYU Grossman School of Medicine, New York, New 
      York, USA.
FAU - Ahuja, Tania
AU  - Ahuja T
AUID- ORCID: 0000-0003-1833-4124
AD  - Department of Medicine, Division of Cardiology, NYU Grossman School of Medicine, 
      New York, New York, USA.
AD  - Department of Pharmacy, NYU Langone Health, New York, New York, USA.
LA  - eng
PT  - Journal Article
DEP - 20231121
PL  - England
TA  - Int J Lab Hematol
JT  - International journal of laboratory hematology
JID - 101300213
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Factor Xa Inhibitors)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Heparin/adverse effects
MH  - Anticoagulants
MH  - Retrospective Studies
MH  - Partial Thromboplastin Time
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - *Pulmonary Embolism/diagnosis/drug therapy
MH  - Hemorrhage/etiology/chemically induced
MH  - *Thromboembolism
MH  - Factor Xa Inhibitors/therapeutic use
OTO - NOTNLM
OT  - PERT
OT  - anti-Xa
OT  - anticoagulation
OT  - heparin
OT  - pulmonary embolism
EDAT- 2023/11/22 00:42
MHDA- 2024/03/20 06:45
CRDT- 2023/11/21 21:12
PHST- 2023/08/31 00:00 [received]
PHST- 2023/11/06 00:00 [accepted]
PHST- 2024/03/20 06:45 [medline]
PHST- 2023/11/22 00:42 [pubmed]
PHST- 2023/11/21 21:12 [entrez]
AID - 10.1111/ijlh.14207 [doi]
PST - ppublish
SO  - Int J Lab Hematol. 2024 Apr;46(2):354-361. doi: 10.1111/ijlh.14207. Epub 2023 Nov 
      21.