Heparin Monitoring with an Anti-Xa Protocol Compared to Activated Clotting Time in Patients on Temporary Mechanical Circulatory Support
| العنوان: | Heparin Monitoring with an Anti-Xa Protocol Compared to Activated Clotting Time in Patients on Temporary Mechanical Circulatory Support |
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| المؤلفون: | Justin N. Tawil, Joseph Rinka, David L. Joyce, Lisa Rein, Nunzio Gaglianello, Joel Feih, Janelle Juul, Kirsten Wallskog, Lisa Baumann Kreuziger |
| المصدر: | Annals of Pharmacotherapy. 56:513-523 |
| بيانات النشر: | SAGE Publications, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, Hematology, medicine.diagnostic_test, Heparin, business.industry, Activated clotting time, Anticoagulants, Hemorrhage, Heparin, Low-Molecular-Weight, Respiratory failure, Internal medicine, Anesthesia, Circulatory system, medicine, Humans, Pharmacology (medical), In patient, Anti factor xa, business, Blood Coagulation, Retrospective Studies, medicine.drug |
| الوصف: | 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. |
| تدمد: | 1542-6270 1060-0280 |
| DOI: | 10.1177/10600280211039582 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9cf8e74c12af47a28d980b8505986c96 https://doi.org/10.1177/10600280211039582 |
| Rights: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....9cf8e74c12af47a28d980b8505986c96 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15426270 10600280 |
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| DOI: | 10.1177/10600280211039582 |