Activated Partial Thromboplastin Time Versus Antifactor Xa Heparin Assay in Monitoring Unfractionated Heparin by Continuous Intravenous Infusion
Activated Partial Thromboplastin Time Versus Antifactor Xa Heparin Assay in Monitoring Unfractionated Heparin by Continuous Intravenous Infusion
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DOI：
10.1345/aph.1q161
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发表时间：
2011-07-01
影响因子：
2.9
通讯作者：
Zumberg, Marc S.
中科院分区：
文献类型：
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作者：
Guervil, David J.;Rosenberg, Amy F.;Zumberg, Marc S.
背景：未分离肝素（UFH）已在临床上使用了50年。尽管UFH是抗凝的基石，但其不可预测的药代动力学特征限制了它的发展，这使得密切的实验室监测成为必要。监测UFH最常见的方法是活化部分凝血活素时间（aPTT）和抗Xa肝素测定（抗Xa HA），但两者都存在挑战，监测UFH的最佳方法仍不清楚。目的：比较aPTT与抗xa HA在监测静脉UFH输注中的有效性和安全性。方法：这是一项单中心、回顾性、观察性队列研究，在一个有852个床位的学术医疗中心进行。结果：100例因各种适应症接受静脉注射UFH的患者被纳入研究；每组50人。与aPTT组相比，抗xa HA组实现治疗性抗凝的平均（SD）时间显著缩短（28[16]比48[16]小时，p < 0.001）。此外，与aPTT患者相比，抗xa HA患者在24小时（OR 3.5; 95% CI 1.5至8.7）和48小时（OR 10.9; 95% CI 3.3至44.2）获得治疗性抗凝治疗的比例更高。抗xa HA组患者在治疗范围内的检测值也更多（66% vs 42%, p < 0.0001）。两组间aPTT / 24h、抗xa HA试验次数（p < 0.0001）、输注速率变化次数（p < 0.01）差异均有统计学意义，均有利于抗xa HA组。结论：与aPTT相比，应用抗xa HA监测UFH静脉输注治疗性抗凝效果更快，维持在目标范围内的时间更长，且需要较少的剂量调整和重复试验。
BACKGROUND: Unfractionated heparin (UFH) has been used clinically for 5 decades. Despite being a cornerstone of anticoagulation, UFH is limited by its unpredictable pharmacokinetic profile, which makes close laboratory monitoring necessary. The most common methods for monitoring UFH are the activated partial thromboplastin time (aPTT) and antifactor Xa heparin assay (anti-Xa HA), but both present challenges, and the optimal method to monitor UFH remains unclear.OBJECTIVE: To compare the performance of the aPTT with the anti-Xa HA for efficiency and safety of monitoring intravenous UFH infusions.METHODS: This was a single-center, retrospective, observational cohort study conducted in an 852-bed academic medical center.RESULTS: One hundred patients receiving intravenous UFH for a variety of indications were enrolled in the study; 50 were assigned to each group. The mean (SD) time to achieve therapeutic anticoagulation was significantly less in the anti-Xa HA group compared with the aPTT group (28 [16] vs 48 [26] hours, p < 0.001). In addition, a greater percentage of anti-Xa HA patients compared to aPTT patients achieved therapeutic anticoagulation at 24 hours (OR 3.5; 95% CI 1.5 to 8.7) and 48 hours (OR 10.9; 95% CI 3.3 to 44.2). Patients in the anti-Xa HA group also had more test values within the therapeutic range (66% vs 42%, p < 0.0001). A significant difference was seen between the 2 groups in the number of aPTT or anti-Xa HA tests performed per 24 hours (p < 0.0001) and number of infusion rate changes per 24 hours (p < 0.01), both favoring the anti-Xa HA group.CONCLUSIONS: Monitoring intravenous UFH infusions with the anti-Xa HA, compared to the aPTT, achieves therapeutic anticoagulation more rapidly, maintains the values within the goal range for a longer time, and requires fewer adjustments in dosage and repeated tests.