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.

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.

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 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 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

Clinical safety and cost of heparin titration using bedside activated clotting time

1993 ◽  
Vol 2 (1) ◽  
pp. 81-87 ◽  
Author(s):  
T Thomason ◽  
B Riegel ◽  
D Jessen ◽  
Smith SCJr ◽  
I Gocka ◽  
...  
Keyword(s):  
Partial Thromboplastin Time ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Clotting Time ◽  
Clinical Safety ◽  
Activated Clotting Time ◽  
Intravenous Heparin ◽  
Transluminal Coronary Angioplasty ◽  
Percutaneous Transluminal

OBJECTIVE: To evaluate the clinical safety of heparin titration and the procedural cost of anticoagulation measurement using bedside low-range activated clotting time. DESIGN: Quasi-experimental study using data gathered through retrospective record review. SETTING: Coronary care, medical intensive care and telemetry units of a community hospital. SUBJECTS: Sample of 102 patients undergoing elective percutaneous transluminal coronary angioplasty. INTERVENTION: Intravenous heparin therapy was titrated using low-range activated clotting time in 51 percutaneous transluminal coronary angioplasty patients. Data from this group were compared to a matched sample of 51 angioplasty patients whose intravenous heparin therapy was titrated using activated partial thromboplastin time. RESULTS: No differences in procedural, early or late complications were found between the groups. The cost of managing heparin therapy with low-range activated clotting time was less than with activated partial thromboplastin time. CONCLUSION: These results suggest that titrating heparin therapy based on bedside low-range activated clotting time for the angioplasty patients in this sample was as safe as with activated partial thromboplastin time. Use of bedside low-range activated clotting time saved money for the hospital.

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.

scholarly journals Preparation of lyophilized partial thromboplastin time reagent composed of synthetic phospholipids: usefulness for monitoring heparin therapy

1997 ◽  
Vol 43 (7) ◽  
pp. 1215-1222 ◽  
Author(s):  
Anton M H P van den Besselaar ◽  
Jacoline Neuteboom ◽  
Joyce Meeuwisse-Braun ◽  
Rogier M Bertina
Keyword(s):  
Oral Anticoagulation ◽  
Partial Thromboplastin Time ◽  
Colloidal Silica ◽  
Factor Xa ◽  
Heparin Therapy ◽  
International Committee ◽  
Heat Degradation ◽  
Intravenous Heparin ◽  
Aptt Reagent ◽  
Apparently Healthy

Abstract To contribute to the development of a reference reagent for monitoring heparin therapy, a lyophilized partial thromboplastin time (PTT) reagent was prepared from synthetic dioleoylphosphatidylcholine, dioleoylphosphatidylserine, and dioleoylphosphatidylethanolamine, with colloidal silica as activator. The reagent, coded 91/558, was contained in sealed glass ampoules; it deteriorated in a heat degradation experiment, but its activity remained constant for at least 4 years when stored at −70 °C. Within- and between-run precision with this reagent complied with the requirements proposed by the International Committee for Standardization in Haematology (ICSH) Panel on PTT. The response of this reagent and of two other reagents to heparin added to pooled normal plasma was nonlinear. Citrated samples from 58 patients receiving intravenous heparin and from 24 apparently healthy volunteers were tested with reagent 91/558, with Automated APTT (Organon Teknika), with Manchester APTT reagent, with an anti-factor Xa assay, and with an anti-factor IIa assay. The correlation of APTT with anti-Xa and anti-IIa activity was poor. The best correlation was observed between reagent 91/558 and the Organon Teknika reagent. Correlations were improved when individual patients’ samples were replaced by pooled plasmas from heparinized patients, in whom the effect of oral anticoagulation was minimal. These results suggest that preparation of a lyophilized synthetic phospholipid reagent is feasible for use in monitoring heparin therapy.

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