scholarly journals Discordance between aPTT and anti-factor Xa levels and implications in patients receiving intravenous unfractionated heparin therapy

2019 ◽  
Vol 7 (30) ◽  
pp. 12-18
Author(s):  
Akwasi Opoku ◽  
Kenneth Iwuji ◽  
Brendon Clough ◽  
Jacqueline Le ◽  
McKenzie Moore ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Partial Thromboplastin Time ◽  
Factor Xa ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Clinical Implications ◽  
Clotting Factors ◽  
Monitoring Protocols ◽  
Plasma Heparin

Heparin, one of the world’s oldest anticoagulation medications, accelerates the rate ofinhibition of previously activated clotting factors. It is most often used in the prophylaxis andtreatment of thromboembolic disorders and complications associated with atrial fibrillation.The two most common ways to monitor plasma heparin levels and anticoagulation therapyare the activated partial thromboplastin time (aPTT) and anti-factor Xa assay (anti-Xa). Thisarticle assesses the performance of aPTT and anti-Xa monitoring protocols and analyzes thediscordance between aPTT and anti-Xa levels and its clinical implications in patients receivingintravenous heparin therapy.

scholarly journals Design and Implementation of an Anti–Factor Xa Heparin Monitoring Protocol

2020 ◽  
Vol 31 (2) ◽  
pp. 129-137
Author(s):  
Tanya Williams-Norwood ◽  
Megan Caswell ◽  
Barbara Milner ◽  
Joseph C. Vescera ◽  
Kelly Prymicz ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Partial Thromboplastin Time ◽  
Factor Xa ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Monitoring Protocol ◽  
Protocol Conversion ◽  
Therapeutic Anticoagulation ◽  
Intravenous Heparin ◽  
Heparin Dosage

Background: The VA Northeast Ohio Healthcare System introduced a new nurse-driven anti–factor Xa (anti-Xa) protocol for monitoring unfractionated heparin to replace the previous activated partial thromboplastin time protocol. Objective: To design, implement, and evaluate the efficacy of the anti-Xa monitoring protocol. Methods: An interdisciplinary team of providers collaborated to develop and implement a nurse-driven, facility-wide anti–factor Xa protocol for monitoring unfractionated heparin therapy. The effectiveness of this protocol was evaluated by retrospective analysis. Results: We reviewed 100 medical records for compliance with the new anti-Xa monitoring protocol. We then evaluated 178 patients whose anticoagulation was monitored with the anti-Xa assay to determine the time to therapeutic range. We found that 80% of patients receiving the anti-Xa protocol achieved therapeutic anticoagulation within 24 hours, as compared with 54% of patients receiving the activated partial thromboplastin time protocol (P < .001). Protocol conversion also yielded a decrease in blood draws, dose adjustments, and potential calculation errors. Conclusions: Monitoring intravenous heparin therapy with the anti-Xa assay rather than activated partial thromboplastin time resulted in a shorter time to therapeutic anticoagulation, longer maintenance of therapeutic levels, and fewer laboratory tests and heparin dosage changes. We believe the current practice of monitoring heparin treatment with activated partial thromboplastin time assays should be reexamined.

Monitoring of Heparin Therapy with the Activated Partial Thromboplastin Time and Chromogenic Substrate Assays

1987 ◽  
Vol 58 (03) ◽  
pp. 853-855 ◽  
Author(s):  
Martin F Fey ◽  
Mathis Lang ◽  
Miha Furlan ◽  
Eugen A Beck
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Partial Thromboplastin Time ◽  
Factor Xa ◽  
Underlying Disease ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Chromogenic Substrate ◽  
Group A ◽  
Plasma Heparin

SummaryHeparin therapy was monitored with the activated partial thromboplastin time (APTT) and with chromogenic substrate assays (factor Xa and factor Ha inhibition) in 100 plasma samples from 47 patients. Heparin concentrations were classified as being below, within or above a defined therapeutic range (TR; 0.2-0.55 units heparin/ml). In a first group of patients (A), all three assays allocated the plasma heparin levels to the same concentration interval with respect to the TR. The most frequent diagnoses in group A were uncomplicated arterial or venous thromboembolism, myocardial infarction with limited tissue necrosis, cardiac surgery without major complications and successfully treated infectious disease. In a second group of patients (B), the results of APTT suggested higher heparin concentrations with respect to the TR than the chromogenic assays. Predominant diagnoses were severe infectious diseases, severe liver disorders, extensive myocardial infarction and postoperative complications after cardiac surgery. The discrepancy between heparin concentrations determined by either APTT or the chromogenic substrate assays is most likely due to a non-heparin related prolongation of APTT caused by the underlying disease.

Impact of a Nurse-Driven Heparin Monitoring Protocol for Ventricular Assist Devices

2021 ◽  
Vol 32 (2) ◽  
pp. 146-151
Author(s):  
Michelle Gannon ◽  
Pamela B. Simone
Keyword(s):  
Unfractionated Heparin ◽  
Partial Thromboplastin Time ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Monitoring Protocol ◽  
Monitoring Protocols ◽  
Heparin Monitoring

Background: Ventricular assist devices require anticoagulation to reduce thrombosis risk. Nurse-driven unfractionated heparin monitoring protocols have been validated for various indications, although data in patients with ventricular assist devices are lacking. Objective: To evaluate a nurse-driven protocol for managing unfractionated heparin therapy in stable patients with ventricular assist devices. Methods: This was a retrospective analysis of adult patients with ventricular assist devices requiring unfractionated heparin therapy, divided into 2 groups: before and after protocol implementation. The primary outcome was time to first therapeutic activated partial thromboplastin time. Results: Each group included 29 patients. There was no difference between the preintervention and postintervention groups in time to therapeutic activated partial thromboplastin time (25 vs 23 hours, P = .95) or proportion of patients with therapeutic activated partial thromboplastin time within the first 24 hours (45% vs 34%, P = .42). Suspected pump thrombosis and bleeding events were similar in the 2 groups. Conclusion: A nurse-driven heparin monitoring protocol was similar in time to therapeutic activated partial thromboplastin time compared with provider-driven monitoring and adjustments in patients with ventricular assist devices.

scholarly journals Discordance in activated partial thromboplastin time and anti-factor Xa levels in COVID-19 patients on heparin therapy

2021 ◽  
Vol 198 ◽  
pp. 79-82
Author(s):  
Matthew Lawlor ◽  
Aakriti Gupta ◽  
Lauren S. Ranard ◽  
Mahesh V. Madhavan ◽  
Jianhua Li ◽  
...  
Keyword(s):  
Partial Thromboplastin Time ◽  
Factor Xa ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time

scholarly journals Clinical outcomes with unfractionated heparin monitored by anti‐factor Xa vs. activated partial Thromboplastin time

2019 ◽  
Vol 94 (9) ◽  
pp. 1015-1019 ◽  
Author(s):  
James C. Coons ◽  
Carlo J. Iasella ◽  
Megan Thornberg ◽  
Mary Grace Fitzmaurice ◽  
Kimberly Goehring ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Clinical Outcomes ◽  
Partial Thromboplastin Time ◽  
Factor Xa ◽  
Activated Partial Thromboplastin Time

The Use of Anti-Xa Assay to Monitor Intravenous Unfractionated Heparin Therapy

2010 ◽  
Vol 23 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Amy Fann Rosenberg ◽  
Marc Zumberg ◽  
Lisa Taylor ◽  
Aimée LeClaire ◽  
Neil Harris
Keyword(s):  
Clinical Trials ◽  
Unfractionated Heparin ◽  
Pediatric Population ◽  
Factor Xa ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Controlled Clinical Trials ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Heparin Activity

Continuous infusion unfractionated heparin (UH) has traditionally been monitored using the activated partial thromboplastin time (aPTT). The use of this test to monitor heparin therapy is not based on randomized controlled clinical trials, and the test is associated with significant intra- and inter-patient variability that is not related to circulating blood heparin activity. Due to these and other limitations, the use of aPTT alone to monitor UF has been questioned. Many laboratories are now transitioning to monitoring actual heparin activity (by anti-factor Xa analysis). In this review, we discuss the limitations of using the aPTT to monitor UH therapy and additionally the limitations of solely using heparin activity to monitor therapy. We also include a discussion of the challenges with monitoring heparin therapy in the pediatric population.

Effectiveness of a Calculation-Free Weight-Based Unfractionated Heparin Nomogram With Anti-Xa Level Monitoring Compared With Activated Partial Thromboplastin Time

2020 ◽  
pp. 106002802096150
Author(s):  
Nicole M. Kindelin ◽  
Ananth M. Anthes ◽  
Sarah M. Providence ◽  
Xinhua Zhao ◽  
Sherrie L. Aspinall
Keyword(s):  
Unfractionated Heparin ◽  
Partial Thromboplastin Time ◽  
Adverse Drug Events ◽  
Factor Xa ◽  
Primary Objective ◽  
Activated Partial Thromboplastin Time ◽  
Historical Control ◽  
Dose Calculations ◽  
Free Weight ◽  
Therapeutic Anticoagulation

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.

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