Evaluation of anti-Xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparin
Background: A 2019 study by Prucnal and colleagues found that the majority of patients treated with unfractionated heparin for pulmonary embolism did not maintain therapeutic activated partial thromboplastin time levels during the first 48 h of therapy. Objective: The purpose of this study was to ev...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2023-08-01
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| Series: | SAGE Open Medicine |
| Online Access: | https://doi.org/10.1177/20503121231190963 |
| _version_ | 1797741335120183296 |
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| author | Lily Nguyen Xiaoxiao Qi Abraham Karimi-asl Alicia Thole Jodi Wendte Tobias Meissner Bing Xu Kyle Dvoracek |
| author_facet | Lily Nguyen Xiaoxiao Qi Abraham Karimi-asl Alicia Thole Jodi Wendte Tobias Meissner Bing Xu Kyle Dvoracek |
| author_sort | Lily Nguyen |
| collection | DOAJ |
| description | Background: A 2019 study by Prucnal and colleagues found that the majority of patients treated with unfractionated heparin for pulmonary embolism did not maintain therapeutic activated partial thromboplastin time levels during the first 48 h of therapy. Objective: The purpose of this study was to evaluate the ability of an institution’s unfractionated heparin dosing protocol to achieve and maintain therapeutic anti-Xa levels within the first 48 h of therapy in patients with venous thromboembolism. Methods : This retrospective study included 205 patients from May 2016 through September 2020. Patients were divided into two cohorts: bolus plus infusion ( N = 89) and infusion only ( N = 116). The primary objective was to determine the number of patients who achieved at least one therapeutic level. Results: Overall, 200 patients (97.6%) had at least one therapeutic level with no statistically significant difference between cohorts ( p = 0.65). No more than 60% of patients achieved a therapeutic level at any of the 6-h intervals throughout the timeframe. The median time to the first therapeutic level in the overall group was 12.8 h with no statistically significant difference between the bolus plus infusion and infusion-only cohorts (13.3 h versus 12.7 h, respectively, p = 0.48). Conclusions: Most patients were able to achieve at least one therapeutic level within the first 48 h, but fewer were able to maintain therapeutic levels. Further studies are warranted to determine whether alternative dosing strategies would yield consistent achievement of therapeutic levels and affect patient-oriented outcomes. |
| first_indexed | 2024-03-12T14:25:19Z |
| format | Article |
| id | doaj.art-7931e7ff309e4743aec806094be62ae5 |
| institution | Directory Open Access Journal |
| issn | 2050-3121 |
| language | English |
| last_indexed | 2024-03-12T14:25:19Z |
| publishDate | 2023-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | SAGE Open Medicine |
| spelling | doaj.art-7931e7ff309e4743aec806094be62ae52023-08-18T08:07:52ZengSAGE PublishingSAGE Open Medicine2050-31212023-08-011110.1177/20503121231190963Evaluation of anti-Xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparinLily Nguyen0Xiaoxiao Qi1Abraham Karimi-asl2Alicia Thole3Jodi Wendte4Tobias Meissner5Bing Xu6Kyle Dvoracek7Department of Pharmacy, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USADepartment of Pharmacy, Nebraska Medicine, Omaha, NE, USADepartment of Pharmacy, Mountain Vista Medical Center, Mesa, AZ, USADepartment of Pharmacy, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USADepartment of Pharmacy, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USADepartment of Cancer Genomics, Avera Cancer Institute Center for Precision Oncology, Sioux Falls, SD, USADepartment of Cancer Genomics, Avera Cancer Institute Center for Precision Oncology, Sioux Falls, SD, USADepartment of Pharmacy, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USABackground: A 2019 study by Prucnal and colleagues found that the majority of patients treated with unfractionated heparin for pulmonary embolism did not maintain therapeutic activated partial thromboplastin time levels during the first 48 h of therapy. Objective: The purpose of this study was to evaluate the ability of an institution’s unfractionated heparin dosing protocol to achieve and maintain therapeutic anti-Xa levels within the first 48 h of therapy in patients with venous thromboembolism. Methods : This retrospective study included 205 patients from May 2016 through September 2020. Patients were divided into two cohorts: bolus plus infusion ( N = 89) and infusion only ( N = 116). The primary objective was to determine the number of patients who achieved at least one therapeutic level. Results: Overall, 200 patients (97.6%) had at least one therapeutic level with no statistically significant difference between cohorts ( p = 0.65). No more than 60% of patients achieved a therapeutic level at any of the 6-h intervals throughout the timeframe. The median time to the first therapeutic level in the overall group was 12.8 h with no statistically significant difference between the bolus plus infusion and infusion-only cohorts (13.3 h versus 12.7 h, respectively, p = 0.48). Conclusions: Most patients were able to achieve at least one therapeutic level within the first 48 h, but fewer were able to maintain therapeutic levels. Further studies are warranted to determine whether alternative dosing strategies would yield consistent achievement of therapeutic levels and affect patient-oriented outcomes.https://doi.org/10.1177/20503121231190963 |
| spellingShingle | Lily Nguyen Xiaoxiao Qi Abraham Karimi-asl Alicia Thole Jodi Wendte Tobias Meissner Bing Xu Kyle Dvoracek Evaluation of anti-Xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparin SAGE Open Medicine |
| title | Evaluation of anti-Xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparin |
| title_full | Evaluation of anti-Xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparin |
| title_fullStr | Evaluation of anti-Xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparin |
| title_full_unstemmed | Evaluation of anti-Xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparin |
| title_short | Evaluation of anti-Xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparin |
| title_sort | evaluation of anti xa levels in patients with venous thromboembolism within the first 48 h of anticoagulation with unfractionated heparin |
| url | https://doi.org/10.1177/20503121231190963 |
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