Agreement between activated partial thromboplastin time and anti-Xa activity in critically ill patients receiving therapeutic unfractionated heparin.

TitreAgreement between activated partial thromboplastin time and anti-Xa activity in critically ill patients receiving therapeutic unfractionated heparin.
Publication TypeJournal Article
Year of Publication2019
AuthorsRatano, D, Alberio, L, Delodder, F, Faouzi, M, Berger, MM
JournalThromb Res
Volume175
Pagination53-58
Date Published03/2019
DOI10.1016/j.thromres.2019.01.002
ISSN1879-2472
Mots-clésActivated partial thromboplastin time, Anti-Xa activity, Anticoagulation, Critical Care, Extracorporeal devices, Unfractionated heparin
Abstract

BACKGROUND: No study supports the use of either aPTT or anti-Xa activity for heparin monitoring in critical care patients. There are no strong data on the agreement between aPTT and anti-Xa. The aims of this study were to: 1. Analyse the agreement between aPTT and anti-Xa in a large population of critically ill patients under unfractionated heparin therapy (UFH), 2. Identify clinical and biological factors associated to agreement or disagreement, and 3. Analyse the impact of anti-Xa availability on the use of aPTT and UFH therapy.

METHODS: Retrospective study in a 35 beds mixed-ICU population between 2006 and 2016 in a University teaching hospital.

INCLUSION CRITERIA: delivery of a UFH dose >15,000 U/24 h during at least one day with one anti-Xa determination.

DATA: demographic variables, aPTT, anti-Xa, laboratory variables, presence of extracorporeal devices (ECD). Pairs of simultaneously dosed aPTT and anti-Xa [aPTT:anti-Xa] were analysed on the basis of their agreement within the sub-therapeutic, therapeutic (aPTT 50-80″, anti-Xa 0.3-0.7 U/ml) or supra-therapeutic ranges.

RESULTS: 2283 patient admissions (2085 patients) were analysed. 35,595 [aPTT:anti-Xa] pairs were found. The overall [aPTT:anti-Xa] agreement was 59.6% and lowest (54.3%) in presence of ECD compared to non-ECD patients (61.6%; p < 0.001). Sixteen demographic and biological variables were analysed and were not predictive of [aPTT:anti-Xa] agreement. No significant difference in administered UFH dose was observed after anti-Xa introduction.

CONCLUSION: In this large cohort, the [aPTT:anti-Xa] agreement is <60% and significantly lower in patients with ECD. None of the variables identified as potentially affecting the agreement were predictive. Availability of anti-Xa had neither effect on aPTT use nor on UFH-dose. These results call for a prospective study to determine the optimal UFH-therapy monitoring tool.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/30708169?dopt=Abstract

WOS ID (UT)

000458802600010

Alternate JournalThromb. Res.
Citation Key / SERVAL ID9367
Peer reviewRefereed
PubMed ID30708169
                         

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