Comparison of Time Within Therapeutic Range Using Anti-Factor Xa Versus Activated Partial Thromboplastin Time Monitoring of Unfractionated Heparin in Children.
Richard J Haftmann, Erika May Pineda, Brent A Hall, Machelle D Wilson, Stephanie N Mateev
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引用次数: 0
Abstract
Objective: To compare unfractionated heparin (UFH) monitoring using time in therapeutic range of activated partial thromboplastin time (aPTT) versus anti-factor Xa activity (anti-Xa) in children.
Methods: This retrospective chart review, with data between October 2015 and October 2019, included pediatric patients younger than 18 years on therapeutic UFH infusion with aPTT or anti-Xa monitoring. Patients receiving extracorporeal membrane oxygenation, dialysis, concomitant anticoagulants, prophylactic UFH, no stated goal, and UFH administered for less than 12 hours were excluded. The primary outcome compared the percentage of time in therapeutic range between aPTT and anti-Xa. Secondary outcomes included time to first therapeutic value, UFH infusion rates, mean rate adjustments, and adverse events.
Results: A total of 65 patients were included, with 33 aPTT patients and 32 anti-Xa patients, representing 39 UFH orders in each group. Baseline characteristics were similar between groups, with an overall mean age of 1.4 years and mean weight of 6.7 kg. The anti-Xa cohort demonstrated a statistically significantly higher percentage of time in therapeutic range compared with the aPTT group (50.3% vs 26.9%, p = 0.002). The anti-Xa group also demonstrated a trend toward decreased time to first therapeutic value compared with aPTT (14 vs 23.2 hours, p = 0.12). Two patients in each group experienced new or worsening thrombosis. Six patients in the aPTT cohort experienced bleeding.
Conclusions: This study demonstrated greater time was spent within therapeutic range for children receiving UFH monitored with anti-Xa compared with aPTT. Future studies should assess clinical outcomes in a larger population.
目的:比较儿童未分离肝素(UFH)监测在治疗范围内的活化部分凝血活素时间(aPTT)和抗Xa因子活性(anti-Xa)。方法:本回顾性图表回顾，数据时间为2015年10月至2019年10月，纳入了18岁以下的儿童患者，这些患者在aPTT或抗xa监测下接受治疗性UFH输注。排除接受体外膜氧合、透析、同时使用抗凝剂、预防性UFH、无明确目标、UFH使用时间少于12小时的患者。主要结果比较了aPTT和抗xa在治疗范围内的时间百分比。次要结局包括到首次治疗价值的时间、UFH输注速率、平均速率调整和不良事件。结果:共纳入65例患者，其中aPTT患者33例，anti-Xa患者32例，每组39个UFH订单。两组患者的基线特征相似，总体平均年龄为1.4岁，平均体重为6.7 kg。与aPTT组相比，抗xa组在治疗范围内的时间百分比具有统计学意义(50.3% vs 26.9%， p = 0.002)。与aPTT相比，抗xa组达到首次治疗价值的时间也有缩短的趋势(14小时vs 23.2小时，p = 0.12)。两组均有2例新发或加重血栓形成。aPTT队列中有6例患者出现出血。结论:本研究表明，与aPTT相比，接受抗xa监测的儿童在治疗范围内花费的时间更长。未来的研究应该在更大的人群中评估临床结果。
期刊介绍：
The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
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