活化部分凝血活酶时间与抗Xa因子测定法在监测住院高胆红素血症患者普通肝素中的一致性
Concordance between Activated Partial Thromboplastin Time and Antifactor Xa Assay for Monitoring Unfractionated Heparin in Hospitalized Hyperbilirubinemic Patients.
作者信息
Mahmoud Leana, Zullo Andrew R, McKaig Donald, Berard-Collins Christine M
机构信息
Neurocritical Care Specialist, Department of Pharmacy, Rhode Island Hospital, Providence, RI.
Investigator, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI; Clinical Pharmacist Specialist, Department of Pharmacy, Rhode Island Hospital, Providence, RI.
出版信息
R I Med J (2013). 2016 Mar 1;99(3):33-7.
BACKGROUND
Activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) monitoring methods for unfractionated heparin (UFH) often disagree. The extent of discordance for those with elevated bilirubin remains unclear. Our objective was to evaluate concordance between activated aPTT and anti-Xa methods for hyperbilirubinemic patients on UFH.
METHODS
This was a retrospective cohort study of 26 patients hospitalized at Rhode Island Hospital between August 2014 and September 2014. Patients had at least one bilirubin measurement >5 mg/dL. After categorizing lab values, percent agreement and kappa were used to examine concordance between aPTT and anti-Xa.
RESULTS
Overall percent agreement between aPTT and anti-Xa was 50%. A nontherapeutic aPTT and therapeutic anti-Xa accounted for 98% of all disagreement. Specifically, 76.7% of disagreement was due to a subtherapeutic aPTT and a therapeutic anti-Xa. Unweighted kappa was 0.141 (95%CI: 0.048-0.235).
CONCLUSION
Concordance between aPTT and anti-Xa values was poor in hyperbilirubinemic patients.
背景
普通肝素（UFH）的活化部分凝血活酶时间（aPTT）监测方法和抗Xa因子（anti-Xa）监测方法常常不一致。胆红素升高患者中这种不一致的程度尚不清楚。我们的目的是评估接受UFH治疗的高胆红素血症患者中活化aPTT和anti-Xa方法之间的一致性。
方法
这是一项对2014年8月至2014年9月在罗德岛医院住院的26例患者进行的回顾性队列研究。患者至少有一次胆红素测量值>5mg/dL。在对实验室值进行分类后，使用一致百分比和kappa值来检验aPTT和anti-Xa之间的一致性。
结果
aPTT和anti-Xa之间的总体一致百分比为50%。所有不一致情况中，非治疗性aPTT和治疗性anti-Xa占98%。具体而言，76.7%的不一致是由于aPTT低于治疗水平而anti-Xa处于治疗水平。未加权kappa值为0.141（95%CI：0.048-0.235）。
结论
高胆红素血症患者中aPTT和anti-Xa值之间的一致性较差。
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