Design and Implementation of an Anti-Factor Xa Heparin Monitoring Protocol.
Design and Implementation of an Anti-Factor Xa Heparin Monitoring Protocol.
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DOI：
10.4037/aacnacc2020132
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发表时间：
2020-06-15
影响因子：
2.2
通讯作者：
Stavrou EX
中科院分区：
文献类型：
--
作者：
Williams-Norwood T;Caswell M;Milner B;Vescera JC;Prymicz K;Ciszak AG;Ingle C;Lacey C;Stavrou EX
退伍军人事务部俄亥俄州东北部医疗系统引入了一种新的护士驱动的抗Xa因子(anti-Xa)方案来监测普通肝素，以取代以前激活的部分凝血活酶时间方案。设计、实施和评估抗Xa监测方案的有效性。一个跨学科的提供者团队合作开发和实施了一种护士驱动的、设施范围内的抗Xa因子方案，用于监测普通肝素治疗。通过回顾分析对该方案的有效性进行评价。我们审查了100份符合新的抗Xa监测方案的医疗记录。然后，我们用抗Xa试验对178例患者进行抗凝监测，以确定达到治疗范围的时间。我们发现，接受抗Xa方案的患者中，80%的患者在24小时内实现了治疗性抗凝，而接受激活的部分凝血活酶时间方案的患者中，这一比例为54%(P<；.001)。方案转换也减少了抽血、剂量调整和潜在的计算误差。用抗Xa试验监测肝素治疗，而不是激活部分凝血活酶时间，可以缩短治疗抗凝时间，延长治疗水平维持时间，减少实验室检查和肝素剂量变化。我们认为，目前用活化的部分凝血活酶时间分析监测肝素治疗的做法应该重新审视。
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. To design, implement, and evaluate the efficacy of the anti-Xa monitoring protocol. 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. 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. 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.
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影响因子：
37.8
作者：
Mehran, Roxana;Rao, Sunil V.;White, Harvey
通讯作者：
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影响因子：
2.2
作者：
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作者：
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DOI：
10.1016/0731-7085(89)80086-x
发表时间：
1989-01-01
影响因子：
3.4
作者：
BARROWCLIFFE, TW;MULLOY, B;THOMAS, DP
通讯作者：
THOMAS, DP
影响因子：
4.1
作者：
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通讯作者：
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