Comparison of Antifactor Xa and Activated Partial Thromboplastin Time Monitoring for Heparin Dosing in Vascular Surgery Patients: A Single-Center Retrospective Study

Rizk, Elsie; Wilson, A.; Murillo, Michelle; Putney, David

doi:10.1097/ftd.0000000000000463

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…This result is consistent with a previous study that showed no difference in major or minor bleeding rates or PRBC transfusions in vascular surgery patients. 12 Whereas Belk et al 13 found that patients diagnosed with stroke, ACS, or VTE across approximately 400 hospitals across the United States required significantly fewer transfusions after transitioning to using anti-Xa monitoring, our study did not find a similar decrease, likely because of the smaller sample size. However, our findings appear to reinforce that the transition to an anti-Xa based protocol seems to be safe in the elderly veteran population, with no increase in bleeding risk.…”

Section: Discussioncontrasting

confidence: 87%

Comparing Anti–Factor Xa and Activated Partial Thromboplastin Levels for Monitoring Unfractionated Heparin

et al. 2019

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Background: Lab tests such as activated partial thromboplastin time (aPTT) or anti–factor Xa (anti-Xa) levels are typically used to monitor intravenous unfractionated heparin (IV heparin), with recent evidence suggesting that anti-Xa levels may provide a more accurate measure of anticoagulation. Objective: The Lexington Veterans Affairs Health Care System transitioned from using aPTT to anti-Xa levels in January 2017. This study was conducted to evaluate the efficacy and safety of this change. Methods: This was a retrospective cohort study comparing all patients receiving IV heparin per protocol for at least 24 hours from August 1, 2016, to January 31, 2017 (aPTT group), and February 1, 2017, to July 31, 2017 (anti-Xa group). The primary objective was a comparison of IV heparin doses required to achieve goal range between the 2 cohorts. Secondary objectives included a comparison of time to therapeutic goal, percentage of time within goal range, number of rate changes until therapeutic goal, and adverse outcomes, such as number of bleeds. Results: A total of 155 patients were included in this study. Significantly higher IV heparin doses were required to achieve therapeutic goal in the anti-Xa group, despite significantly fewer IV heparin rate changes required. Anti-Xa monitoring was not associated with an increased risk of adverse events. Conclusion and Relevance: Significantly higher IV heparin doses were required to achieve therapeutic anti-Xa levels after transitioning from an aPTT-based protocol in the largely unstudied veteran population. However, the transition from aPTT to anti-Xa monitoring appears safe and efficacious in these patients.

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Section: Discussioncontrasting

confidence: 87%

Comparing Anti–Factor Xa and Activated Partial Thromboplastin Levels for Monitoring Unfractionated Heparin

et al. 2019

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“…24 Anti-FXa levels is preferred to monitor heparin activity to aPTT because anti-FXa assay directly reflects functional activity of heparin and less affected by patient and analytic variables. 27 Moreover, elevated factor VIII and fibrinogen levels and increased plasma heparinbinding proteins during pregnancy can also cause a resistance to aPTT test, which makes it a poor sensitive test to monitor the efficacy and safety of heparin treatment as compared with heparin anti-FXa levels which is not affected. 27,28 The blunted aPTT response to therapeutic heparin during pregnancy can result in over-anticoagulation and increased the risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…27 Moreover, elevated factor VIII and fibrinogen levels and increased plasma heparinbinding proteins during pregnancy can also cause a resistance to aPTT test, which makes it a poor sensitive test to monitor the efficacy and safety of heparin treatment as compared with heparin anti-FXa levels which is not affected. 27,28 The blunted aPTT response to therapeutic heparin during pregnancy can result in over-anticoagulation and increased the risk of bleeding. However, true heparin resistance can occur in patients with antithrombin deficiency, increased clearance, or increased heparin-binding proteins (often considered acute phase reactant).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Continuation of Low-Molecular-Weight Heparin versus Switching to Unfractionated Heparin in the Peripartum

2019

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Objective This study aimed to determine whether switching from low-molecular-weight heparin (LMWH) to unfractionated heparin (UFH) or its continuation in the peripartum affected anesthesia choice or bleeding complications. Study Design A retrospective cohort study of 189 anticoagulated pregnant women who delivered at the University of Illinois at Chicago Hospital and Health Science System from 2005 to 2016. Demography, anesthesia choice, and bleeding complications were compared between the two groups. Results There were 138 (73%) women on LMWH versus 51 (27%) who switched from LMWH to UFH during the peripartum. The demographics were similar, 123 women were on prophylactic: 81 (66%) were on LMWH and 42 (34%) switched to UFH. Of the 66 women on therapeutic anticoagulation, 57 (86%) continued on LMWH, while 9 (14%) switched to UFH. No difference in neuraxial anesthesia type received: 42 (82.4%) versus 108 (79.7%) women (odds ratio: 1.20, 95% confidence interval [CI]: 0.52–2.73, p = 0.837). Bleeding complications more than 1,000 mL, 6 versus 10% (relative risk [RR]: 0.58, 95% CI: 0.17–1.94, p = 0.380) and relaparotomy due to hemoperitoneum, 2% in either group (RR: 0.9, 95% CI: 0.10–8.48, p = 0.930) were similar in the two groups regardless of time of last injection. Conclusion Anesthesia type and rate of bleeding complications were similar between women on LMWH and UFH during the peripartum.

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“…Anticoagulant dosing of obese patients with PE remains to be an area that has not been well studied [72]. The bulk of the data comes from pharmacokinetic/ pharmacodynamic (PK/PD) studies and subgroup analyses of premarketing trials comparing obese patients to patients with normal body weight [52][53][54]72]. Furthermore, warfarin appears to have the most robust data available in this population.…”

Section: Special Population 91 Obesitymentioning

confidence: 99%

“…These studies enrolled some patients with BMIs >35 kg/m 2 and found clinical benefits comparable across all weight groups [58]. The authors of this analysis also concluded that standard doses should be sufficient to treat obese patients; however, a review questioned whether the data were robust enough to draw that conclusion [52,58].…”

Section: Special Population 91 Obesitymentioning

confidence: 99%

Anticoagulants in the Management of Pulmonary Embolism

Panahi¹,

Udeani²,

Horseman³

et al. 2022

New Knowledge About Pulmonary Thromoboembolism

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Pulmonary embolism management has typically been accomplished with anticoagulant treatment that includes parenteral heparins and oral vitamin K antagonists. Even though heparins and oral vitamin K antagonists continue to play a role in pulmonary embolism management, other newer available options have somewhat reduced the role of heparins and vitamin K antagonists in pulmonary embolism management. This reduction in utilization involves their toxicity profile, clearance limitations, and many drug and nutrient interactions. New direct oral anticoagulation therapies have led to more available options in the management of pulmonary embolism in the inpatient and outpatient settings. More evidence and research are now available about reversal agents and monitoring parameters regarding these newer agents, leading to more interest in administering them for safe and effective pulmonary embolism management. Current research and literature have also helped direct the selection of appropriate use of pharmacological management of pulmonary embolism based on the specific population such as patients with liver failure, renal failure, malignancy, and COVID-19.

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Comparison of Antifactor Xa and Activated Partial Thromboplastin Time Monitoring for Heparin Dosing in Vascular Surgery Patients: A Single-Center Retrospective Study

Cited by 6 publications

References 12 publications

Comparing Anti–Factor Xa and Activated Partial Thromboplastin Levels for Monitoring Unfractionated Heparin

Comparing Anti–Factor Xa and Activated Partial Thromboplastin Levels for Monitoring Unfractionated Heparin

Comparison of Continuation of Low-Molecular-Weight Heparin versus Switching to Unfractionated Heparin in the Peripartum

Anticoagulants in the Management of Pulmonary Embolism

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