Controversies in heparin monitoring

Zehnder, James L.; Price, Elizabeth; Jin, Jing

doi:10.1002/ajh.23210

Cited by 12 publications

(11 citation statements)

References 36 publications

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“…In addition, a recent retrospective study has shown that routine monitoring and heparin dose adjustment may be unnecessary for patients receiving doses of at least 30 000 units/day [ 75 ], as for these patients, the mean proportion of time with an aPTT of 0.2 anti-Xa IU/mL was 92%. The monitoring is also performed to prevent bleeding but its utility is still controversial [ 76 ].…”

Section: Biological Monitoring Of Anticoagulant Treatmentsmentioning

confidence: 99%

Measurement of non-VKA oral anticoagulants versus classic ones: the appropriate use of hemostasis assays

et al. 2014

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Traditional anticoagulant agents such as vitamin K antagonists (VKAs), unfractionated heparin (UFH), low molecular weight heparins (LMWHs) and fondaparinux have been widely used in the prevention and treatment of thromboembolic diseases. However, these agents are associated with limitations, such as the need for regular coagulation monitoring (VKAs and UFH) or a parenteral route of administration (UFH, LMWHs and fondaparinux).Several non-VKA oral anticoagulants (NOACs) are now widely used in the prevention and treatment of thromboembolic diseases and in stroke prevention in non-valvular atrial fibrillation. Unlike VKAs, NOACs exhibit predictable pharmacokinetics and pharmacodynamics. They are therefore usually given at fixed doses without routine coagulation monitoring. However, in certain patient populations or special clinical circumstances, measurement of drug exposure may be useful, such as in suspected overdose, in patients experiencing a hemorrhagic or thromboembolic event during the treatment’s period, in those with acute renal failure, in patients who require urgent surgery or in case of an invasive procedure. This article aims at providing guidance on laboratory testing of classic anticoagulants and NOACs.Electronic supplementary materialThe online version of this article (doi:10.1186/1477-9560-12-24) contains supplementary material, which is available to authorized users.

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Section: Biological Monitoring Of Anticoagulant Treatmentsmentioning

confidence: 99%

Measurement of non-VKA oral anticoagulants versus classic ones: the appropriate use of hemostasis assays

et al. 2014

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“…4 UFH activity is monitored by activated partial thromboplastin time (aPTT), with a therapeutic range between 1.5 and 2.5 times normal to achieve full anticoagulation. 4 UFH may also be monitored through anti-Xa levels. 4 MBE occurs in approximately 3% of patients receiving UFH for acute venous thromboembolism (VTE) treatment.…”

Section: Heparinsmentioning

confidence: 99%

A Historical Perspective on the Reversal of Anticoagulants

Salter

Crowther

2022

Semin Thromb Hemost

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There has been a landmark shift in the last several decades in the management and prevention of thromboembolic events. From the discovery of parenteral and oral agents requiring frequent monitoring as early as 1914, to the development of direct oral anticoagulants (DOACs) that do not require monitoring or dose adjustment in the late 20th century, great advances have been achieved. Despite the advent of these newer agents, bleeding continues to be a key complication, affecting 2 to 4% of DOAC-treated patients per year. Bleeding is associated with substantial morbidity and mortality. Although specific reversal agents for DOACs have lagged the release of these agents, idarucizumab and andexanet alfa are now available as antagonists. However, the efficacy of these reversal agents is uncertain, and complications, including thrombosis, have not been adequately explored. As such, guidelines continue to advise the use of nonspecific prohemostatic agents for patients requiring reversal of the anticoagulant effect of these drugs. As the indications for DOACs and the overall prevalence of their use expand, there is an unmet need for further studies to determine the efficacy of specific compared with nonspecific pro-hemostatic reversal agents. In this review, we will discuss the evidence behind specific and nonspecific reversal agents for both parenteral and oral anticoagulants.

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“…A pre‐COVID study of 539 hospitalized patients receiving UFH found that patients with disproportionately prolonged APTT readings compared with anti‐Xa values had worse clinical outcomes. The authors suggested that concurrent measurement of both readings could be useful in stratifying bleeding risk and determining dose 51 . This may reflect the fact that, although anti‐Xa may be a direct measure of heparin concentration, it does not always correlate with global hemostatic state 52 .…”

Section: Can Anti‐xa Be Helpful To “Detecting” Heparin Resistance?mentioning

confidence: 99%

Heparin – Messias or Verschlimmbesserung?

Swan

Carrier

Lisman

et al. 2021

Journal of Thrombosis and Haemostasis

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A heightened risk of thrombosis noted early on with the severe acute respiratory syndrome coronavirus 2 infection led to the widespread use of heparin anticoagulation in the coronavirus disease 2019 (COVID‐19) pandemic. However, reports soon started appearing in the literature where an apparent failure of heparin to prevent thrombotic events was observed in hospitalized patients with this viral infection. In this review, we explore the likely mechanisms for heparin failure with particular relevance to COVID‐19. We also explore the role of anti‐Xa assays and global hemostatic tests in this context. The current controversy of dosing heparin in this disease is detailed with some possible mechanistic reasons for anticoagulant failure. We hope that lessons learnt from the use of heparin in COVID‐19 could assist us in the appropriate use of this anticoagulant in the future.

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Controversies in heparin monitoring

Cited by 12 publications

References 36 publications

Measurement of non-VKA oral anticoagulants versus classic ones: the appropriate use of hemostasis assays

Measurement of non-VKA oral anticoagulants versus classic ones: the appropriate use of hemostasis assays

A Historical Perspective on the Reversal of Anticoagulants

Heparin – Messias or Verschlimmbesserung?

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