Anti-Xa assays: What is their role today in antithrombotic therapy?

Hutt, Erika; Militello, Michael; Gomes, Marcelo

doi:10.3949/ccjm.86a.18029

Cited by 28 publications

(26 citation statements)

References 88 publications

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“…27 Since antiphospholipid antibodies and lupus anticoagulant have been reported in COVID-19, we recommend testing for these, if the aPTT is spontaneously elevated, and prefer the use of anti-Xa assays to monitor anticoagulation. Anti-Xa assay may, however, be affected by high levels of bilirubin (6.6 mg/ dL) or triglycerides (> 360 mg/dL), 28 which are often elevated in COVID-19 patients with cytokine storm. Triglyceride levels should therefore be monitored routinely and considered as a possible source of error in patients on anticoagulation that are diffi cult to maintain within therapeutic target range.…”

Section: ■ Laboratory Testingmentioning

confidence: 99%

Coagulopathy in COVID-19: Manifestations and management

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Dugar

McCrae

et al. 2020

CCJM

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Section: ■ Laboratory Testingmentioning

confidence: 99%

Coagulopathy in COVID-19: Manifestations and management

Mucha

Dugar

McCrae

et al. 2020

CCJM

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“…Another approach that could be adopted to optimise the antithrombotic prophylaxis in this clinical setting is the monitoring of anti-activated coagulation factor X (Xa) activity. Despite many limitations, anti-Xa assay remains the only available method to monitor LMWH efficacy [41]. Similarly, a very strict monitoring of activated partial thromboplastin time (aPTT) could be of help when UFH is chosen.…”

Section: Covid-19 and Venous Thromboembolism: Current Insights And Prophylactic Strategiesmentioning

confidence: 99%

COVID-19 and venous thromboembolism: current insights and prophylactic strategies

et al. 2020

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“…Hypertriglyceridemia was defined as a triglyceride level >360 mg/dL and hyperbilirubinemia as a bilirubin level >6.6 mg/dL because values exceeding these cutoffs may interfere with the anti-Xa assay. 11,23 UFH dose adjustments and laboratory values were recorded for the entire duration of UFH therapy. Total body weight was recorded and used for all patients across all weight ranges.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of a Calculation-Free Weight-Based Unfractionated Heparin Nomogram With Anti-Xa Level Monitoring Compared With Activated Partial Thromboplastin Time

et al. 2020

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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.

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Anti-Xa assays: What is their role today in antithrombotic therapy?

Cited by 28 publications

References 88 publications

Coagulopathy in COVID-19: Manifestations and management

Coagulopathy in COVID-19: Manifestations and management

COVID-19 and venous thromboembolism: current insights and prophylactic strategies

Effectiveness of a Calculation-Free Weight-Based Unfractionated Heparin Nomogram With Anti-Xa Level Monitoring Compared With Activated Partial Thromboplastin Time

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