Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Pharmacy Department, Beth Israel Deaconess Medical Center, Boston, MA, United States of America.
Int J Cardiol. 2024 Dec 15;417:132495. doi: 10.1016/j.ijcard.2024.132495. Epub 2024 Aug 30.
The objective of this study was to compare the effectiveness and safety of anti-Xa-guided management versus aPTT-guided management of intravenous (IV) unfractionated heparin (UFH) in patients with a durable ventricular assist device (VAD).
This was a retrospective study conducted at a single academic medical center. Patients were included if they had a durable VAD and were managed using aPTT-guided UFH management from May 2019 to May 2020 or were managed using anti-Xa-guided UFH management from May 2021 to December 2021. The primary outcome of the study was the median time to goal anticoagulation post-initiation of UFH. Secondary outcomes included the percentage of time within the therapeutic range and the incidence of thromboembolic and bleeding complications.
The study included 23 patients, 12 of whom were managed using anti-Xa-guided UFH, and 11 were managed using aPTT-guided UFH. The treatment arm using anti-Xa-guided UFH demonstrated a faster time to therapeutic anticoagulation goal range with a median time of 21.3 h [IQR = 12.2-34.8] compared to 37.3 h [IQR = 41-74] in the aPTT-guided UFH treatment arm (P = 0.03). In addition, the anti-Xa-guided UFH arm had a higher percentage of time within the therapeutic range, 76 % [IQR = 64.25-96.25] compared to 53 % [IQR = 41-74] in the aPTT-guided UFH arm (P = 0.04). Both arms had no significant differences in major bleeding events (P = 0.59) or clinically relevant minor bleeding events (P = 0.60) among patients. There was no incidence of thromboembolic events in either treatment arm.
Based on this single-center experience, anti-Xa-guided UFH management resulted in a faster time to therapeutic anticoagulation and a longer time within the desired therapeutic range. The results suggest that anti-Xa-guided monitoring may be superior to UFH-guided monitoring in patients with a durable VAD.
本研究旨在比较抗 Xa 管理与 aPTT 管理对使用静脉（IV）未分级肝素（UFH）的持久性心室辅助装置（VAD）患者的有效性和安全性。
这是一项在一家学术医疗中心进行的回顾性研究。纳入标准为：患者具有持久性 VAD，2019 年 5 月至 2020 年 5 月期间接受 aPTT 指导 UFH 管理，或 2021 年 5 月至 2021 年 12 月期间接受抗 Xa 指导 UFH 管理。该研究的主要结局是启动 UFH 治疗后达到目标抗凝的中位时间。次要结局包括治疗范围内的时间百分比以及血栓栓塞和出血并发症的发生率。
该研究纳入 23 例患者，其中 12 例接受抗 Xa 指导 UFH 治疗，11 例接受 aPTT 指导 UFH 治疗。使用抗 Xa 指导 UFH 的治疗组达到治疗抗凝目标范围的时间更快，中位时间为 21.3 小时[IQR=12.2-34.8]，而 aPTT 指导 UFH 治疗组为 37.3 小时[IQR=41-74]（P=0.03）。此外，抗 Xa 指导 UFH 组治疗范围内的时间百分比更高，为 76%[IQR=64.25-96.25]，而 aPTT 指导 UFH 组为 53%[IQR=41-74]（P=0.04）。两组患者大出血事件（P=0.59）或有临床意义的轻微出血事件（P=0.60）发生率均无显著差异。两组均未发生血栓栓塞事件。
基于这项单中心经验，抗 Xa 指导 UFH 管理可更快达到治疗抗凝效果，并在更长时间内维持在所需的治疗范围内。结果表明，在持久性 VAD 患者中，抗 Xa 监测可能优于 UFH 监测。
