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Clinical outcomes with unfractionated heparin monitored by anti‐factor Xa vs. activated partial Thromboplastin time
Author(s) -
Coons James C.,
Iasella Carlo J.,
Thornberg Megan,
Fitzmaurice Mary Grace,
Goehring Kimberly,
Jablonski Lindsay,
Leader Dominic,
Meyer Abby,
Seo Hangil,
Benedict Neal J.,
Smith Roy E.
Publication year - 2019
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.25565
Subject(s) - partial thromboplastin time , medicine , nomogram , heparin , venous thrombosis , anesthesia , thrombosis , retrospective cohort study , coagulation
Anti‐factor Xa (anti‐Xa) monitoring of unfractionated heparin (UFH) is associated with less time to achieve therapeutic anticoagulation compared to the activated partial thromboplastin time (aPTT). However, it is unknown whether clinical outcomes differ between these methods of monitoring. The aim of this research was to compare the rate of venous thrombosis and bleeding events in patients that received UFH monitored by anti‐Xa compared to the aPTT. A retrospective review of electronic health records identified adult patients that received UFH given intravenously (IV) for ≥2 days, with either anti‐Xa or aPTT monitoring at an academic tertiary care hospital. This was a pre/post study design conducted between January 1 to December 30, 2014 (aPTT), and January 1 to December 30, 2016 (anti‐Xa). All UFH adjustments were based on institutional nomograms. The primary outcome was venous thrombosis and the secondary outcome was bleeding, both of which occurred between UFH administration and discharge from the index hospitalization. A total of 2500 patients were in the anti‐Xa group and 2847 patients aPTT group. Venous thrombosis occurred in 10.2% vs 10.8% of patients in the anti‐Xa and aPTT groups, respectively ( P = .49). Bleeding occurred in 33.7% vs 33.6% of patients in the anti‐Xa and aPTT groups, respectively ( P = .94). Anti‐Xa monitoring was not an independent predictor of either outcome in multivariate logistic regression analyses. Our study found no difference in clinical outcomes between anti‐Xa and aPTT‐based monitoring of UFH IV.