Plasma anti-FXa level as a surrogate marker of the adequacy of thromboprophylaxis in critically ill patients: A systematic review

Vahtera, Annukka; Vaara, Suvi T.; Pettilä, Ville; Kuitunen, Anne

doi:10.1016/j.thromres.2015.12.016

Cited by 17 publications

(28 citation statements)

References 41 publications

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“…We found that continuous intravenous enoxaparin infusion as thromboprophylaxis therapy resulted in lower plasma anti-FXa concentration than standard subcutaneous administration during the first 24 h. No associations between anti-FXa concentration and clinical endpoints (bleeding or thromboembolic complications) were detected. This result supports our previous findings [4].…”

Section: Discussionsupporting

confidence: 94%

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Plasma anti-FXa concentration after continuous intravenous infusion and subcutaneous dosing of enoxaparin for thromboprophylaxis in critically ill patients. A randomized clinical trial

Vahtera

Valkonen

Huhtala

et al. 2017

Thrombosis Research

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Section: Discussionsupporting

confidence: 94%

“…The monitoring of anticoagulant effect is not generally recommended when using LMWHs [3]. Nonetheless, the measurement of plasma anti-factor Xa (anti-FXa) concentration has been described, although its efficacy as a means of monitoring therapeutic effect and association with clinical thromboembolic events is thought to be inadequate [4].…”

Section: Introductionmentioning

confidence: 99%

Plasma anti-FXa concentration after continuous intravenous infusion and subcutaneous dosing of enoxaparin for thromboprophylaxis in critically ill patients. A randomized clinical trial

Vahtera

Valkonen

Huhtala

et al. 2017

Thrombosis Research

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“…However, previous trials have shown inadequate Anti-Xa response in critically unwell patients, including those with acute burns (10,11). The clinical implication of this subtherapeutic response in terms of VTE diagnoses is unclear (12).…”

Section: Introductionmentioning

confidence: 98%

Prophylactic anti-coagulation after severe burn injury in critical care settings

Blake

Roadley-Battin

Torliński

2019

AML

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Background. Severely burnt patients are at an increased risk of thromboembolic complications, hence sufficient prophylactic anticoagulation is of paramount importance. Local guidelines at the Burns Centre in the Queen Elizabeth Hospital, Birmingham therefore advise increasing the standard dose of low molecular weight heparin in these patients. An audit was carried out to assess the current practice in burns patients to ensure adequate anticoagulation and adherence to guidelines. Materials and methods. Retrospective data was collected on all burns patients in the Burns Centre over a two-year period. The main objectives were to assess: • anticoagulation regimes prescribed to severe burns patients • monitoring of Anti-Factor Xa levels • adjustment of dosing based on the results The locally produced trust guidelines were used as the comparator. Results. All burns patients were prescribed anticoagulation, but often the dose was not increased as suggested in the guidelines. Although most of the severely burnt patients were prescribed adjusted higher doses of anti-coagulation, only 60% of these patients were monitored with Anti-Factor Xa assays. Of these assays, 66% showed sub-prophylactic levels. The majority of results led to the adjustment of the dose of anticoagulant. However, often dose changes were made late. Discussion and conclusions. The audit confirmed the need for increased doses of prophylactic anticoagulation in severe burns. The better adherence to the guidelines can be achieved by additional training and implementation of decision support via electronic prescribing system.

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“…20 In critically ill patients, the incidence of VTE varies form 5 to 16% despite standardized pharmacologic prophylaxis. 27 Therefore, anticoagulant monitoring could be indicated in these patients. VCAs could help find the correct dose in cases where aPTT and anti-Xa testing are not conclusive.…”

Section: Viscoelastic Coagulation Assays In Different Patient Populatmentioning

confidence: 99%

Point-of-Care Testing in Burn Patients

Wiegele

Kozek‐Langenecker²,

Schaden

2017

Semin Thromb Hemost

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Severe burn injury has an impact on the coagulation system, but a unique definition regarding these changes is still missing. The results of conventional coagulation assays (CCAs) measured in daily clinical practice are often interpreted as coagulopathic, which implies a bleeding tendency. However, viscoelastic coagulation assays (VCA) like Rotational Thromboelastometry (ROTEM) and Thromboelastography (TEG) depict a hypercoagulable state. Therefore, hemostatic interventions should not be indicated according to deranged CCA results, but only in case of clinically relevant bleeding plus indicative VCA results. Massive blood loss mainly results from surgical excision of burn wounds. VCAs seem to be capable of guiding target-oriented coagulation management in this context. Owing to the increased thromboembolic risk, it appears rational to individualize pharmacologic venous thromboembolism prophylaxis by using sensitive laboratory tests and drug monitoring. Studies evaluating the use of new VCA test modifications are highly warranted and may substantially improve outcome in this difficult-to-treat patient population.

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Plasma anti-FXa level as a surrogate marker of the adequacy of thromboprophylaxis in critically ill patients: A systematic review

Abstract: Based on the current literature, no definite conclusions can be drawn on targeted anti-FXa level in critically ill patients when using LMWH thromboprophylaxis.

Cited by 17 publications

References 41 publications

Plasma anti-FXa concentration after continuous intravenous infusion and subcutaneous dosing of enoxaparin for thromboprophylaxis in critically ill patients. A randomized clinical trial

Plasma anti-FXa concentration after continuous intravenous infusion and subcutaneous dosing of enoxaparin for thromboprophylaxis in critically ill patients. A randomized clinical trial

Prophylactic anti-coagulation after severe burn injury in critical care settings

Point-of-Care Testing in Burn Patients

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