Preliminary insights into monitoring bivalirudin anticoagulation: A retrospective cohort study of aPTT versus a chromogenic anti-IIa assay

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-01 DOI:10.1016/j.jclinane.2025.111836

Sean G. Yates , Ravi Sarode , Markus Velten , Jennifer Thibodeau , Abe DeAnda Jr , Ibrahim F. Ibrahim , Lisa Skariah

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引用次数: 0

Abstract

Background

Bivalirudin infusions are traditionally monitored with activated partial thromboplastin time (aPTT) despite the poor correlation with bivalirudin dose-response curves. This discordance may lead to over or under-anticoagulation, predisposing patients to bleeding or thrombosis and repeated dose adjustments. While a chromogenic bivalirudin-specific anti-IIa assay, which measures bivalirudin plasma concentrations, is available, the extent to which this test may improve clinical monitoring and patient outcomes remains unclear. Accordingly, we aimed to retrospectively assess the correlation between the bivalirudin dose and the anti-IIa assay and to establish a therapeutic range. We then performed a retrospective comparative cohort study assessing the impact of anti-IIa monitoring compared to aPTT on patient outcomes.

Methods

Plasma samples from adults receiving bivalirudin anticoagulation were analyzed to assess the correlation between bivalirudin dose, aPTT, and the anti-IIa assay. A retrospective comparative analysis was then conducted to evaluate operational and clinical outcomes in patients monitored with aPTT versus the anti-IIa assay.

Results

Analysis of 127 samples from 11 bivalirudin-anticoagulated adults showed a very weak correlation between bivalirudin dose and aPTT (r² = 0.08), while a strong correlation was seen with the anti-IIa assay (r² = 0.65). The dose-response slope's coefficient of variation (CV) for the aPTT and anti-IIa assay were 31 % and 6.6 %, respectively. Patients monitored with the anti-IIa assay had significantly higher time in therapeutic range than those monitored with aPTT (92.1 % vs. 26 %, p < 0.001).

Conclusions

These findings suggest that the anti-IIa assay provides more reliable bivalirudin monitoring than aPTT, with a significant reduction in minor bleeding.

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对比伐鲁定抗凝监测的初步见解：aPTT与显色抗iia测定的回顾性队列研究

传统上，比伐鲁定输注是用活化部分凝血活素时间（aPTT）来监测的，尽管它与比伐鲁定的剂量-反应曲线相关性很差。这种不一致可能导致抗凝作用过度或不足，使患者易出血或血栓形成，并反复调整剂量。虽然有一种比伐鲁丁特异性显色抗iia测定法，可以测量比伐鲁丁的血浆浓度，但该试验在多大程度上可以改善临床监测和患者预后仍不清楚。因此，我们旨在回顾性评估比伐鲁定剂量与抗iia测定之间的相关性，并建立一个治疗范围。然后，我们进行了一项回顾性比较队列研究，评估与aPTT相比，抗iia监测对患者预后的影响。方法对接受比伐鲁定抗凝治疗的成人血浆样本进行分析，评估比伐鲁定剂量、aPTT与抗iia测定的相关性。然后进行回顾性比较分析，以评估aPTT监测患者与抗iia检测患者的手术和临床结果。结果11例比伐鲁丁抗凝成人127例aPTT与比伐鲁丁剂量相关性极弱（r2 = 0.08），与抗iia浓度相关性极强（r2 = 0.65）。aPTT和抗iia试验的剂量-反应斜率变异系数（CV）分别为31%和6.6%。用抗iia检测的患者在治疗范围内的时间明显高于用aPTT监测的患者(92.1% vs. 26%, p <；0.001)。结论抗iia检测比aPTT提供了更可靠的比伐鲁定监测，可显著减少轻微出血。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.