NOV 08, 2017 6:00 AM PST

How to Monitor Heparin Therapy: Still a Controversy

Speaker
  • Clinical Research Scientist, 59th CRD
    Biography
      David L. McGlasson, MS. MLS(ASCP)cm was a staff researcher at the 59th Clinical Research Division at Lackland JBSA in San Antonio, TX until his retirement.. He has published 166 abstracts, 76 manuscripts, 9 book chapters, three patents and one book. Mr. McGlasson has also presented more than 200 lectures at local, state, national and international levels. He is the 9 time winner of the American Clinical Laboratory Science Award for scientific research and has received the Kendall-Sherwood Award, the Bio-Rad award for scientific achievement in Hematology. He also has won numerous poster competitions at many meetings. To include the Society of Armed Forces Laboratory Science, International Society of Thrombosis and Hemostasis and American Society of Clinical Laboratory Science. He currently is a consulatant in the area of Hemostasis and Thrombosis.

    Abstract

    Monitoring unfractionated heparin (UFH) using the activated partial thromboplastin time (APTT) or the anti-factor Xa (anti-Xa) chromogenic assay still seems to be a controversy.  Is the anti-Xa less affected by pre-analytical variables in monitoring subjects on UFH and the low molecular weight heparins (LMWH)?  Which assay is more accurate in monitoring heparin to achieve therapeutic levels, cost effective in time spent monitoring patients, use of blood products, time in the hospital, and overall cost which may include laboratory testing time.  The APTT still is the most commonly used assay to monitor UFH therapy but cannot be used to monitor the LMWHs.  Previous studies have cited interference in monitoring UFH with the  APTT from oral anticoagulants, oral contraceptives, lupus anticoagulants, factor deficiencies, elevated acute phase reactants (fibrinogen, FVIII), low anti-thrombin, the APTT reagent sensitivity and instrumentation.  The anti-Xa assay may be affected by hyperbilirubinemia, hyperlipidemia (can be cleared by ultracentrifugation) and decreased anti-thrombin levels (assay dependent). The anti-Xa assay can be used to monitor all heparin analogues and direct oral anticoagulants (DOACs).  This presentation will discuss the pros and cons of both methods and which may be most effective in patient care.


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