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Establishing the heparin therapeutic range using aPTT and anti-Xa measurements for monitoring unfractionated heparin therapy

대한혈액학회지 2016년 51권 3호 p.171 ~ 174
변정현 ( Byun Jung-Hyun ) - Gyeongsang National University School of Medicine Department of Laboratory Medicine

장인석 ( Jang In-Seok ) - Gyeongsang National University School of Medicine Department of Thoracic and Cardiovascular Surgery
김종우 ( Kim Jong-Woo ) - Gyeongsang National University School of Medicine Department of Thoracic and Cardiovascular Surgery
고은하 ( Koh Eun-Ha ) - Gyeongsang National University School of Medicine Department of Laboratory Medicine

Abstract


Background: Unfractionated heparin (UFH) has unstable pharmacokinetics and requires close monitoring. The activated partial thromboplastin time (aPTT) test has been used to monitor UFH therapy for decades in Korea, but its results can be affected by numerous variables. We established an aPTT heparin therapeutic range (HTR) corresponding to therapeutic anti-Xa levels for continuous intravenous UFH administration, and used appropriate monitoring to determine if an adequate dose of UFH was applied.

Methods: A total of 134 ex vivo samples were obtained from 71 patients with a variety of thromboembolisms. All patients received intravenous UFH therapy and were enrolled from June to September 2015 at Gyeongsang National University Hospital. All laboratory protocols were in accordance with the Clinical and Laboratory Standards Institute guidelines and the College of American Pathologist requirements for aPTT HTR.

Results: An aPTT range of 87.1 sec to 128.7 sec corresponded to anti-Xa levels of 0.3 IU/mL to 0.7 IU/mL for HTR under our laboratory conditions. Based on their anti-Xa levels, blood specimen distribution were as follows: less than 0.3 IU/mL, 65.7%; 0.3?0.7 IU/mL (therapeutic range), 33.6%; and more than 0.7 IU/mL, 0.7%. No evidence of recurring thromboembolism was observed.

Conclusion: Using the conventional aPTT target range may lead to inappropriate dosing of UFH. Transitioning from the aPTT test to the anti-Xa assay is required to avoid the laborious validation of the aPTT HTR test, even though the anti-Xa assay is more expensive.

키워드

Chromogenic anti-Xa test assay; Unfractionated heparin (UFH); Activated partial thromboplastin time (aPTT); Heparin therapeutic range (HTR)
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