Antifactor Xa levels vs. activated partial thromboplastin time for monitoring unfractionated heparin. A pilot study
Antifactor Xa levels vs. activated partial thromboplastin time for monitoring unfractionated heparin. A pilot study
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DOI：
10.1111/jcpt.12415
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发表时间：
2016-10-01
影响因子：
2
通讯作者：
Choi, H. A.
中科院分区：
文献类型：
--
作者：
Samuel, S.;Allison, T. A.;Choi, H. A.
监测普通肝素（UFH）输注的两种最常用的方法是活化部分凝血活酶时间（aPTT）和抗Xa因子肝素测定（抗Xa）。本研究的目的是比较aPTT方案与抗Xa方案在成人患者中的性能，定义为达到治疗范围的时间、数值在目标范围内的时间百分比和进行实验室监测的次数。然后，我们分析了抗Xa和aPTT的配对值之间的不一致性。MethodsThis是一个单中心的前瞻性队列试点研究，从2013年9月1日至2014年5月31日进行。aPTT和抗Xa值排序的次数（中位数，IQR）为14（2-34）vs 7（2-76）; P = 0.23。达到治疗范围的时间（小时）为（平均值，SD）22（20）aPTT vs 15（13）抗Xa; P = 0.08。在aPTT组中仅5名（10%）患者达到治疗范围（>50-100%的时间），而在抗Xa组中为21名（57%）; P <0.01。在aPTT组的38名患者（78%）中观察到超治疗值（>50-100%），而在抗Xa组的14名患者（38%）中观察到超治疗值（>50-100%）; P < 001。使用37例患者的234个配对值评价aPTT和抗Xa之间的不一致性。57%的时间抗Xa和aPTT值之间不一致。两名患者有出血并发症，需要输血或中断后试点protocol.What是新的和conclusionUtilizing抗Xa协议监测肝素输注显示有利的结果相比，利用aPTT协议，通过保持值在治疗目标范围内。我们研究中最常见的不一致模式是aPTT与抗Xa值不成比例的延长。与高aPTT正常抗Xa值的不一致值的患者可能有出血complications.What是已知的和目标的风险增加监测普通肝素（UFH）输注的两种最常见的方法是活化部分凝血活酶时间（aPTT）和抗凝血因子Xa肝素测定（抗Xa）。本研究的目的是比较aPTT方案与抗Xa方案在成人患者中的性能，定义为达到治疗范围的时间、数值在目标范围内的时间百分比和进行实验室监测的次数。然后，我们分析了抗Xa和aPTT配对值之间的不一致性。方法这是一项单中心前瞻性队列试点研究，于2013年9月1日至2014年5月31日进行。结果85例患者接受UFH治疗，48例接受aPTT监测，37例接受抗Xa监测。aPTT和抗Xa值排序的次数（中位数，IQR）为14（2-34）vs 7（2-76）; P = 0.23。达到治疗范围的时间（小时）为（平均值，SD）22（20）aPTT vs 15（13）抗Xa; P = 0.08。在aPTT组中仅5名（10%）患者达到治疗范围（>50-100%的时间），而在抗Xa组中为21名（57%）; P <0.01。在aPTT组的38名患者（78%）中观察到超治疗值（>50-100%），而在抗Xa组的14名患者（38%）中观察到超治疗值（>50-100%）; P < 001。使用37例患者的234个配对值评价aPTT和抗Xa之间的不一致性。57%的时间抗Xa和aPTT值之间不一致。2例患者发生出血并发症，需要输血或中止试验后方案。什么是新的和结论利用抗Xa协议，以监测肝素输注显示有利的结果相比，利用aPTT协议，通过保持在治疗目标范围内的值。我们研究中最常见的不一致模式是aPTT与抗Xa值不成比例的延长。aPTT与抗Xa正常值相比偏高的不一致值患者发生出血并发症的风险可能增加。
What is known and objectivesThe two most common methods for monitoring unfractionated heparin (UFH) infusion are the activated partial thromboplastin time (aPTT) and the antifactor Xa heparin assay (anti-Xa). The purpose of this study is to compare the performance of an aPTT protocol vs. an anti-Xa protocol in adult patients as defined by the time to reach therapeutic range, the percentage of time the values were within the goal range and the number of times laboratory monitoring was conducted. We then analysed the discordance between paired values of anti-Xa and aPTT.MethodsThis was a single-centre prospective cohort pilot study conducted from 1 September 2013 to 31 May 2014.ResultsEighty-five patients were treated with UFH infusion, aPTT monitoring (n = 48), anti-Xa monitoring (n = 37). The number of times aPTT and anti-Xa values were ordered was (median, IQR) 14 (2-34) vs 7 (2-76); P = 023. The time to reach therapeutic range in hours was (mean, SD) 22 (20) aPTT vs 15 (13) anti-Xa; P = 008. Therapeutic range (>50-100% of the time) was achieved in only 5 (10%) patients in the aPTT group vs. 21 (57%) in the anti-Xa group; P < 001. Supratherapeutic values (>50-100%) were observed in 38 (78%) patients in the aPTT group vs. 14 (38%) in the anti-Xa group; P < 001. The discordance between aPTT and anti-Xa was evaluated using 234 paired values from 37 patients. There was discordance between anti-Xa and aPTT values 57% of the time. Two patients had bleeding complications requiring blood transfusion or discontinuation of post-pilot protocol.What is new and conclusionUtilizing an anti-Xa protocol to monitor heparin infusion showed favourable results compared with utilizing an aPTT protocol by maintaining values within the therapeutic goal range. The most common discordant pattern in our study was a disproportionate prolongation of aPTT to anti-Xa values. Patients with discordant values presenting with high aPTT to normal anti-Xa values may have an increased risk of bleeding complications.What is known and objectives The two most common methods for monitoring unfractionated heparin (UFH) infusion are the activated partial thromboplastin time (aPTT) and the antifactor Xa heparin assay (anti-Xa). The purpose of this study is to compare the performance of an aPTT protocol vs. an anti-Xa protocol in adult patients as defined by the time to reach therapeutic range, the percentage of time the values were within the goal range and the number of times laboratory monitoring was conducted. We then analysed the discordance between paired values of anti-Xa and aPTT. Methods This was a single-centre prospective cohort pilot study conducted from 1 September 2013 to 31 May 2014. Results Eighty-five patients were treated with UFH infusion, aPTT monitoring (n = 48), anti-Xa monitoring (n = 37). The number of times aPTT and anti-Xa values were ordered was (median, IQR) 14 (2-34) vs 7 (2-76); P = 023. The time to reach therapeutic range in hours was (mean, SD) 22 (20) aPTT vs 15 (13) anti-Xa; P = 008. Therapeutic range (>50-100% of the time) was achieved in only 5 (10%) patients in the aPTT group vs. 21 (57%) in the anti-Xa group; P < 001. Supratherapeutic values (>50-100%) were observed in 38 (78%) patients in the aPTT group vs. 14 (38%) in the anti-Xa group; P < 001. The discordance between aPTT and anti-Xa was evaluated using 234 paired values from 37 patients. There was discordance between anti-Xa and aPTT values 57% of the time. Two patients had bleeding complications requiring blood transfusion or discontinuation of post-pilot protocol. What is new and conclusion Utilizing an anti-Xa protocol to monitor heparin infusion showed favourable results compared with utilizing an aPTT protocol by maintaining values within the therapeutic goal range. The most common discordant pattern in our study was a disproportionate prolongation of aPTT to anti-Xa values. Patients with discordant values presenting with high aPTT to normal anti-Xa values may have an increased risk of bleeding complications.