Anti-factor Xa and activated partial thromboplastin time measurements for heparin monitoring in mechanical circulatory support

JACC. Heart Failure
Sirtaz AdatyaNicole D Zantek

Abstract

This study investigated the relationship between anti-factor Xa (anti-FXa) and activated partial thromboplastin time (aPTT) for monitoring intravenous unfractionated heparin (IV-UFH) in patients with continuous-flow left ventricular assist devices (CF-LVADs). CF-LVADs have become mainstream therapy for patients with advanced heart failure. Thromboembolic events, device thrombosis, and bleeding continue to be a challenge with this technology. Adequate anticoagulation is required to prevent these adverse events. A prospective study of consecutive patients implanted with a CF-LVAD was conducted. Paired samples were considered concordant if aPTT values fell into expected ranges for subtherapeutic, therapeutic, and supratherapeutic anti-FXa levels. Heparin dosing was on the basis of anti-Xa levels. A total of 340 paired values from 38 patients were evaluated. Anti-FXa and aPTT were discordant in 253 samples (74.4%), with a high degree of variability in aPTT for any given anti-FXa level (r(2) = 0.57). Results were discordant in 104 samples (63.8%) from patients undergoing bridging therapy with warfarin and in 149 samples (84.2%) from patients with device obstruction and/or hemolysis (p < 0.001). The most common pattern of discordance...Continue Reading

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Citations

Dec 17, 2015·Journal of the American College of Cardiology·Nir UrielMandeep R Mehra
Aug 26, 2015·Journal of Thrombosis and Haemostasis : JTH·S SusenP J Lenting
Jul 25, 2015·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Martin SchweigerManuela Albisetti
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