Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA.
Division of Laboratory Medicine, Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, USA.
Am J Clin Pathol. 2022 Mar 3;157(3):321-327. doi: 10.1093/ajcp/aqab135.
Monitoring is essential to safe anticoagulation prescribing and requires close collaboration among pathologists, clinicians, and pharmacists.
We describe our experience in the evolving strategy for laboratory testing of unfractionated heparin (UFH).
An intrainstitutional investigation revealed significant discordance between activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) assays, prompting a transition from the former to the latter in 2013. With the increasing use of oral factor Xa inhibitors (eg, apixaban, rivaroxaban, edoxaban, betrixaban), which interfere with the anti-Xa assay, we adapted our protocol again to incorporate aPTT in patients admitted on oral Xa inhibitors who require transition to UFH.
Our experience demonstrates key challenges in anticoagulation and highlights the importance of clinical pathologists in helping health systems adapt to the changing anticoagulation landscape.
监测对于安全的抗凝药物处方至关重要，需要病理学家、临床医生和药剂师之间密切合作。
我们描述了我们在未分级肝素（UFH）实验室检测不断发展的策略方面的经验。
一项院内调查显示，活化部分凝血活酶时间（aPTT）和抗因子 Xa（anti-Xa）检测之间存在显著差异，这促使我们在 2013 年从前者过渡到后者。随着口服因子 Xa 抑制剂（如阿哌沙班、利伐沙班、依度沙班、贝曲沙班）的使用越来越多，这些抑制剂会干扰抗-Xa 检测，因此我们再次调整了方案，在需要从口服 Xa 抑制剂转换为 UFH 的口服 Xa 抑制剂入院患者中纳入 aPTT。
我们的经验表明抗凝治疗存在关键挑战，并强调了临床病理学家在帮助卫生系统适应不断变化的抗凝治疗领域中的重要性。
