Heparin Monitoring with an Anti-Xa Protocol Compared to Activated Clotting Time in Patients on Temporary Mechanical Circulatory Support
BACKGROUND: Temporary mechanical circulatory support (tMCS) devices are used for patients with severe cardiac or respiratory failure; however, these patients are at high risk for clotting and bleeding. The best method to monitor heparin in these patients has not been established.
OBJECTIVE: To determine the risks for bleeding and clotting while monitoring heparin with either anti-Xa or activated clotting time (ACT) in tMCS patients.
METHODS: A retrospective cohort study was conducted on tMCS patients who received heparin adjusted according to an anti-Xa or ACT protocol. The primary outcome was incidence of major bleeding. Pertinent secondary outcomes were individual components of the primary outcome, clotting events, and time to therapeutic range.
RESULTS: There were 103 patients included in the study: 53 in the ACT group and 50 in the anti-Xa group. Overall, there were 30 (56.6%) patients with major bleeding in the ACT group, compared with 16 (32%) patients in the anti-Xa group (P = 0.017). An anti-Xa-based protocol was associated with a decreased hazard of major bleeding (hazard ratio = 0.388 [0.215-0.701]; P = 0.002) in the univariate analysis. In the multivariable analysis, an anti-Xa protocol remained associated with a significantly lower hazard of bleeding. Findings were similar when broken down into more discrete subgroups of the entire cohort, extracorporeal membrane oxygenation life support (ECMO), and non-ECMO groups.
CONCLUSION AND RELEVANCE: Anti-Xa monitoring was associated with a lower hazard of bleeding during tMCS compared to an ACT-based protocol. Further studies should evaluate if anti-Xa monitoring should be preferentially used in tMCS.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:56 |
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| Enthalten in: |
The Annals of pharmacotherapy - 56(2022), 5 vom: 07. Mai, Seite 513-523 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Feih, Joel T [VerfasserIn] |
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| Links: |
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| Themen: |
9005-49-6 |
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| Anmerkungen: |
Date Completed 28.04.2022 Date Revised 25.05.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1177/10600280211039582 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM32967031X |
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| 100 | 1 | |a Feih, Joel T |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Heparin Monitoring with an Anti-Xa Protocol Compared to Activated Clotting Time in Patients on Temporary Mechanical Circulatory Support |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Temporary mechanical circulatory support (tMCS) devices are used for patients with severe cardiac or respiratory failure; however, these patients are at high risk for clotting and bleeding. The best method to monitor heparin in these patients has not been established | ||
| 520 | |a OBJECTIVE: To determine the risks for bleeding and clotting while monitoring heparin with either anti-Xa or activated clotting time (ACT) in tMCS patients | ||
| 520 | |a METHODS: A retrospective cohort study was conducted on tMCS patients who received heparin adjusted according to an anti-Xa or ACT protocol. The primary outcome was incidence of major bleeding. Pertinent secondary outcomes were individual components of the primary outcome, clotting events, and time to therapeutic range | ||
| 520 | |a RESULTS: There were 103 patients included in the study: 53 in the ACT group and 50 in the anti-Xa group. Overall, there were 30 (56.6%) patients with major bleeding in the ACT group, compared with 16 (32%) patients in the anti-Xa group (P = 0.017). An anti-Xa-based protocol was associated with a decreased hazard of major bleeding (hazard ratio = 0.388 [0.215-0.701]; P = 0.002) in the univariate analysis. In the multivariable analysis, an anti-Xa protocol remained associated with a significantly lower hazard of bleeding. Findings were similar when broken down into more discrete subgroups of the entire cohort, extracorporeal membrane oxygenation life support (ECMO), and non-ECMO groups | ||
| 520 | |a CONCLUSION AND RELEVANCE: Anti-Xa monitoring was associated with a lower hazard of bleeding during tMCS compared to an ACT-based protocol. Further studies should evaluate if anti-Xa monitoring should be preferentially used in tMCS | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a anti-factor Xa | |
| 650 | 4 | |a anticoagulants | |
| 650 | 4 | |a critical care | |
| 650 | 4 | |a hematology | |
| 650 | 4 | |a heparin | |
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| 700 | 1 | |a Wallskog, Kirsten E |e verfasserin |4 aut | |
| 700 | 1 | |a Rinka, Joseph R G |e verfasserin |4 aut | |
| 700 | 1 | |a Juul, Janelle J |e verfasserin |4 aut | |
| 700 | 1 | |a Rein, Lisa |e verfasserin |4 aut | |
| 700 | 1 | |a Gaglianello, Nunzio |e verfasserin |4 aut | |
| 700 | 1 | |a Baumann Kreuziger, Lisa M |e verfasserin |4 aut | |
| 700 | 1 | |a Joyce, David L |e verfasserin |4 aut | |
| 700 | 1 | |a Tawil, Justin N |e verfasserin |4 aut | |
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