• Emily Whitman-Purves, James C Coons, Taylor Miller, Jeannine V DiNella, Andrew Althouse, Mark Schmidhofer, and Roy E Smith.
• 1 Presbyterian-Shadyside Hospital, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
• Clin. Appl. Thromb. Hemost. 2018 Mar 1; 24 (2): 310-316.

AbstractThe purpose of this study was to compare the performance of anti-factor Xa concentration versus activated partial thromboplastin time (aPTT) monitoring with multiple indication-specific heparin nomograms. This was a prospective, nonrandomized study with historical control at a large academic medical center. A total of 201 patients who received intravenous heparin in the cardiology units were included. The prospective cohort included patients (n = 101) with anti-factor Xa (anti-Xa) monitoring, and the historical control group included patients (n = 100) who had aPTT monitoring. Patients in the prospective group had both anti-Xa and aPTT samples drawn, but anti-Xa was used for dosing adjustment. The anti-Xa cohort achieved a significantly faster time to therapeutic range ( P < .01) and required fewer dose adjustments per 24-hour period compared to the aPTT control ( P = .01). Results were consistent across heparin nomograms. The overall discordance rate between the 2 tests was 49%. No significant differences in clinical outcomes were observed. In summary, anti-Xa monitoring improved the time to therapeutic anticoagulation and led to fewer dose adjustments compared to the aPTT with multiple indication-based heparin nomograms.

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