From Activated Partial Thromboplastin Time to Antifactor Xa and Back AgainThe Evolution of Monitoring Unfractionated Heparin

Author:

May Jori E1ORCID,Siniard Rance Chad2,Taylor Laura J3,Marques Marisa B2,Gangaraju Radhika14

Affiliation:

1. Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA

2. Division of Laboratory Medicine, Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, USA

3. UAB Coagulation Service, School of Medicine, University of Alabama at Birmingham, Birmingham, USA

4. Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, USA

Abstract

Abstract Objectives Monitoring is essential to safe anticoagulation prescribing and requires close collaboration among pathologists, clinicians, and pharmacists. Methods We describe our experience in the evolving strategy for laboratory testing of unfractionated heparin (UFH). Results An intrainstitutional investigation revealed significant discordance between activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) assays, prompting a transition from the former to the latter in 2013. With the increasing use of oral factor Xa inhibitors (eg, apixaban, rivaroxaban, edoxaban, betrixaban), which interfere with the anti-Xa assay, we adapted our protocol again to incorporate aPTT in patients admitted on oral Xa inhibitors who require transition to UFH. Conclusions Our experience demonstrates key challenges in anticoagulation and highlights the importance of clinical pathologists in helping health systems adapt to the changing anticoagulation landscape.

Funder

National Center for Advancing Translational Sciences

Publisher

Oxford University Press (OUP)

Subject

General Medicine

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