Key result
An anti-Xa titration scale met noninferiority criteria compared to an aPTT scale for the composite of death, major bleeding, or new thrombosis during UFH transitions (P=0.138 for superiority).
Why the study?
Data are inadequate regarding the optimal strategy for transitioning patients from factor Xa inhibitors to unfractionated heparin infusions.
Does monitoring UFH infusions utilizing an UFH-calibrated anti-Xa titration scale reduce the composite of death, major bleeding, or new thrombosis compared to an aPTT titration scale in adult patients transitioning from a factor Xa inhibitor to an UFH infusion?
Cohort
Yes
Does monitoring UFH infusions utilizing an UFH-calibrated anti-Xa titration scale reduce the composite of death, major bleeding, or new thrombosis compared to an aPTT titration scale in adult patients transitioning from a factor Xa inhibitor to an UFH infusion?
p-value: p=0.138 for superiority
A transition guideline utilizing an UFH-calibrated anti-Xa assay is a safe, noninferior alternative to aPTT monitoring for patients transitioning from a factor Xa inhibitor to an unfractionated heparin infusion.
Supports anti-Xa titration as noninferior alternative to aPTT for UFH transitions; leaves open need for randomized confirmation.
BACKGROUND: There are inadequate data on the optimal strategy for transitioning factor Xa inhibitors (FXai; apixaban, rivaroxaban) to unfractionated heparin (UFH) infusions. OBJECTIVE: In patients transitioning from an FXai to an UFH infusion, this study compared the safety and efficacy of monitoring UFH infusions using an activated partial thromboplastin time (aPTT) titration scale versus utilizing an UFH-calibrated anti-Xa titration scale aided by a novel institutional guideline. METHODS: A retrospective cohort analysis was conducted on adult patients transitioning from an FXai to an UFH infusion at 2 medical centers from June 1, 2018, to November 1, 2020. One institution utilized aPTT while the other institution primarily used UFH-calibrated anti-Xa. The primary endpoint was a composite of death, major bleeding, or new thrombosis during the hospitalization with a planned noninferiority analysis. Secondary outcomes were also collected including the amount and duration of UFH administered between cohorts. RESULTS: = 0.138 for superiority) meeting noninferiority criteria. No statistical differences were seen in new thrombosis, major bleeding, or any bleeding. CONCLUSION AND RELEVANCE: This represents the first report of a comparison between aPTT versus anti-Xa monitoring in relation to clinical outcomes for patients transitioning from an FXai to an UFH infusion. A transition guideline primarily utilizing an UFH-calibrated anti-Xa assay appears to be a safe alternative to aPTT monitoring and can aid facilities in the management of patients during these complex transitions.
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Dingus et al. (2022) conducted a cohort in Transitioning from factor Xa inhibitor to unfractionated heparin infusion. UFH-calibrated anti-Xa titration scale vs. aPTT titration scale was evaluated on composite of death, major bleeding, or new thrombosis during the hospitalization (p=0.138 for superiority). An anti-Xa titration scale met noninferiority criteria compared to an aPTT scale for the composite of death, major bleeding, or new thrombosis during UFH transitions (P=0.138 for superiority).
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