Reassessment of dextran sulfate in anti-Xa assay for unfractionated heparin laboratory monitoring

Hardy, Michael; Cabo, Julien; Deliège, Antoine; Douxfils, Jonathan; Gouin-Thibault, Isabelle; Lecompte, Thomas; Mullier, François

doi:10.1016/j.rpth.2023.102257

Research and Practice in Thrombosis and Haemostasis

2023

DOI: 10.1016/j.rpth.2023.102257

|View full text |Cite

Reassessment of dextran sulfate in anti-Xa assay for unfractionated heparin laboratory monitoring

Michael Hardy,

Julien Cabo,

Antoine Deliège

et al.

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2024

Publication Types

Select...

Article5

Relationship

Self Cite0

Independent5

Authors

Journals

Cited by 5 publications

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Management of Therapeutic-intensity Unfractionated Heparin: A Narrative Review on Critical Points

Gouin-Thibault,

Mansour,

Hardy

et al. 2024

TH Open

View full text Add to dashboard Cite

Nowadays, unfractionated heparin (UFH) use is limited to selected patient groups at high risk of both bleeding and thrombosis (patients in cardiac surgery, in intensive care unit and patients with severe renal impairment), rendering its management extremely challenging, with many unresolved questions despite decades of use. In this narrative review, we revisit the fundamental concepts of therapeutic anticoagulation with UFH and address five key points, summarizing controversies underlying the use of UFH and discussing the few recent advances in the field: 1/ laboratory tests for UFH monitoring have significant limitations; 2/ therapeutic ranges are not well-grounded; 3/ the actual influence of antithrombin levels on UFH’s anticoagulant activity is not well established; 4/ the concept of UFH resistance lacks supporting data; 5/ scarce data are available on UFH use beyond acute VTE. We therefore identified key issues to be appropriately addressed in future clinical research: (i) while anti-Xa assays are often considered as the preferred option, we call for a vigorous action to improve understanding of the differences between types of anti-Xa assays and to solve the issue of the usefulness of added dextran; (ii) therapeutic ranges for UFH, which were defined decades ago using reagents no longer available, have not been properly validated and need to be confirmed or re-established; (iii) UFH dose adjustment nomograms require full validation.

show abstract

Management of Therapeutic-intensity Unfractionated Heparin: A Narrative Review on Critical Points

Gouin-Thibault,

Mansour,

Hardy

et al. 2024

TH Open

View full text Add to dashboard Cite

show abstract

Pleiotropic Effects of Heparin and its Monitoring in the Clinical Practice

Arachchillage,

Kitchen

2024

Semin Thromb Hemost

View full text Add to dashboard Cite

Unfractionated heparin (UFH) was uncovered in 1916, has been used as an anticoagulant since 1935, and has been listed in the World Health Organization's Model List of Essential Medicines. Despite the availability of many other anticoagulants, the use of heparin (either low molecular weight heparin [LMWH] or UFH) is still substantial. Heparin has pleotropic effects including anticoagulant and several nonanticoagulant properties such as antiproliferative, anti-inflammatory activity, and anticomplement effects. Although UFH has been widely replaced by LMWH, UFH is still the preferred anticoagulant of choice for patients undergoing cardiopulmonary bypass surgery, extracorporeal membrane oxygenation, and patients with high-risk mechanical cardiac valves requiring temporary bridging with a parenteral anticoagulant. UFH is a highly negatively charged molecule and binds many positively charged molecules, hence has unpredictable pharmacokinetics, and variable anticoagulant effect on an individual patient basis. Therefore, anticoagulant effects of UFH may not be proportional to the dose of UFH given to any individual patient. In this review, we discuss the anticoagulant and nonanticoagulant activities of UFH, differences between UFH and LMWH, when to use UFH, different methods of monitoring the anticoagulant effects of UFH (including activated partial thromboplastin time, heparin anti-Xa activity level, and activated clotting time), while discussing pros and cons related to each method and comparison of clinical outcomes in patients treated with UFH monitored with different methods based on available evidence.

show abstract

Antithrombin Levels during Venoarterial ECMO: Reply

Mansour,

Lecompte,

Nesseler

et al. 2024

Anesthesiology

View full text Add to dashboard Cite

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Reassessment of dextran sulfate in anti-Xa assay for unfractionated heparin laboratory monitoring

Cited by 5 publications

References 43 publications

Management of Therapeutic-intensity Unfractionated Heparin: A Narrative Review on Critical Points

Management of Therapeutic-intensity Unfractionated Heparin: A Narrative Review on Critical Points

Pleiotropic Effects of Heparin and its Monitoring in the Clinical Practice

Antithrombin Levels during Venoarterial ECMO: Reply

Contact Info

Product

Resources

About