Key result
When the Heparin IV DOAC Interference PowerPlan was not ordered, 7% (4 of 56) of reported apixaban events involved a thrombotic event within 7 days of UFH initiation.
Why the study?
Guidance is lacking for managing oral factor Xa inhibitor interference with heparin anti-Xa monitoring during intravenous unfractionated heparin therapy, leading to substantial clinical uncertainty.
Does a standardized electronic order set (PowerPlan) reduce thrombotic events in patients with oral factor Xa inhibitor interference during intravenous unfractionated heparin monitoring?
Cohort (n=169)
No
Does a standardized electronic order set (PowerPlan) reduce thrombotic events in patients with oral factor Xa inhibitor interference during intravenous unfractionated heparin monitoring?
Implementation of a standardized electronic order set for managing oral factor Xa inhibitor interference with heparin anti-Xa monitoring may help mitigate the risk of thrombotic events.
BACKGROUND: Oral factor Xa inhibitors are known to significantly increase heparin anti-Xa concentrations, which leads to inaccuracies when monitoring intravenous unfractionated heparin (IV UFH). Guidance for managing this laboratory interference is lacking, creating substantial uncertainty in clinical practice. OBJECTIVE: To describe a strategy used by a large academic institution for managing the controversy of laboratory interference in the setting of oral factor Xa inhibitor use and provide effectiveness and safety data for this approach. METHODS: In December 2016, a new Heparin IV Direct Oral Anticoagulant (DOAC) Interference PowerPlan (a comprehensive order set) was made available in the electronic health record (Cerner, North Kansas City, MO) throughout the health system. We retrospectively examined 169 patients with events reported in the error reporting system, RISKMASTER, and evaluated reports with and without the use of the PowerPlan. Effectiveness was determined through evaluation of thrombosis. The Naranjo criteria for causality were applied to assess thrombotic events. RESULTS: Of 56 events that were reported with apixaban when the PowerPlan was not ordered, 4 (7%) thrombotic events occurred within 7 days of UFH initiation. One out of the 4 events (25%) that occurred when the PowerPlan was not appropriately initiated was considered probable using the Naranjo Scale. Three additional events (75%) were possible using the Naranjo Scale. CONCLUSION AND RELEVANCE: The Heparin IV DOAC Interference PowerPlan appears to be conducive to positive patient outcomes when evaluating voluntary reported events and may assist clinicians with managing the therapeutic dilemma of this laboratory interference.
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Levito et al. (2020) conducted a cohort in Oral factor Xa inhibitor interference with UFH anti-Xa concentrations (n=169). Heparin IV DOAC Interference PowerPlan vs. No PowerPlan ordered was evaluated on Thrombotic events within 7 days of UFH initiation. When the Heparin IV DOAC Interference PowerPlan was not ordered, 7% (4 of 56) of reported apixaban events involved a thrombotic event within 7 days of UFH initiation.
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