Key result
Monitoring continuous unfractionated heparin infusion with antifactor Xa assay significantly increased the percentage of critically ill obstetric patients reaching therapeutic levels at 12 hours (76% vs 46%) compared to aPTT monitoring.
Why the study?
Unfractionated heparin infusion therapy requires tight monitoring to prevent hemorrhagic and thrombotic complications, but the optimal monitoring tool in critically ill pregnant females remains unclear.
Does anti-Xa assay monitoring improve the rate of reaching therapeutic anticoagulation levels compared to aPTT monitoring in critically ill pregnant females receiving continuous unfractionated heparin?
RCT (n=100)
Open-label
Computer-generated random number table and sealed opaque envelops
No
Does anti-Xa assay monitoring improve the rate of reaching therapeutic anticoagulation levels compared to aPTT monitoring in critically ill pregnant females receiving continuous unfractionated heparin?
Absolute Event Rate: 76% vs 46%
p-value: p=0.007
Monitoring continuous unfractionated heparin with anti-Xa assays rather than aPTT in critically ill pregnant women leads to faster achievement of therapeutic anticoagulation with lower total heparin doses.
Anti-Xa monitoring may accelerate therapeutic UFH anticoagulation in critically ill obstetric patients; extends RCT evidence to this population.
Unfractionated heparin (UFH) infusion therapy needs accurate tight control to prevent overanticoagulation that may result in hemorrhagic complications and also to prevent sub therapeutic level that may result in thrombotic complications. The aim of this study was to compare the most popular monitoring tool activated aPTT versus antifactor Xa to reach accurate monitor to UFH therapy in critically ill pregnant females. Time to reach therapeutic level as well as total heparin dose required to reach this therapeutic level were much lower in the anti-Xa group when compared to aPTT group. The use of anti-Xa-based protocol to monitor UFH infusion therapy resulted in better therapeutic control as it resulted in earlier achievement of therapeutic level and lower heparin dose requitments.
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Zaki et al. (2019) conducted an RCT in Critically ill obstetric patients requiring unfractionated heparin infusion (n=100). Antifactor Xa assay monitoring vs. Activated partial thromboplastin time (aPTT) monitoring was evaluated on Percentage of patients who reached therapeutic anticoagulation level at 12 hours (p=0.007). Monitoring continuous unfractionated heparin infusion with antifactor Xa assay significantly increased the percentage of critically ill obstetric patients reaching therapeutic levels at 12 hours (76% vs 46%) compared to aPTT monitoring.
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