APR 23, 2018 08:00 AM PDT

UFH monitoring focusing on use of anti-Xa for critically ill and general patient management

C.E. CREDITS: P.A.C.E. CE | Florida CE
Speakers
  • Professor of Anesthesiology, Professor of Surgery (Cardiothoracic), CoDirector, Cardiothoracic ICU, Duke University Hospital
    Biography
      Dr. Jerrold Levy is Professor of Anesthesiology and Surgery (Cardiothoracic) and Co-director of the Cardiothoracic Surgical Intensive Care Unit at Duke University Medical Center. He obtained his medical degree from the University of Miami, and undertook his residency and fellowships at the Massachusetts General Hospital and Harvard Medical School, Boston. His clinical and research interests include therapeutic strategies to prevent and treat bleeding; anticoagulation and its reversal, clinical applications of recombinant and purified protein concentrates, therapeutic approaches to shock/ventricular dysfunction, and anaphylaxis.

    Abstract:

    Despite the development of new anticoagulants, unfractionated heparin (UFH) continues to be a primary choice for intravenous anticoagulant therapy because of its titratability, short half-life, ability to use in patients with renal failure, and acute reversibility. UFH continues to be the mainstay of parenteral anticoagulation especially in critically ill patients and to maintain anticoagulation during mechanical cardiopulmonary support.  As with all intravenous anticoagulants, monitoring is required for its use. In critically ill patients, UFH can be monitored by multiple tests that include the activated partial thromboplastin time (aPTT), heparin activity measured by antifactor Xa (anti-Xa), or activated clotting time (ACT). Although the aPTT and the ACT are frequently used for monitoring, there are multiple limitations. Anti-Xa heparin monitoring represents an important alternative, and I routinely used anti-Xa monitoring as our standard of measurement in my previous institution. However, aPTT is the standard for monitoring in my current institution.  Despite this, I frequently use anti-Xa monitoring as an important guide to therapy especially in critically ill, complex patients especially during ECMO and mechanical cardiopulmonary support. Anti-Xa monitoring is a more direct measure of UFH activity than the aPTT, demonstrates less variability and is most helpful when conflicting values occur during aPTT monitoring.  In this presentation, I will review UFH monitoring focusing on the use of the anti-Xa for critically ill and general patient management.

    Learning Objectives

    • Summarize different methods for heparin monitoring in the ICU and hospital
    • Describe limitations and benefits of different testing focusing on anti-Xa monitoring
    • Discuss the role of anti-Xa monitoring and clinical applications in critically ill patients

    Show Resources
    You May Also Like
    AUG 15, 2018 08:00 AM PDT
    C.E. CREDITS
    AUG 15, 2018 08:00 AM PDT
    DATE: August 15, 2018TIME: 08:00AM PDT, 11:00AM EDTThe failure of current chemotherapeutic strategies in the fight against cancer can be largely attributed to the occurrence of drug res...
    MAY 03, 2018 11:00 AM PDT
    MAY 03, 2018 11:00 AM PDT
    DATE: May 3, 2018TIME: 11:00AM PDT, 2:00PM EDTWhile stress is one of the leading causes of neuropsychiatric disorders, the molecular underpinnings of how stress induces alterations in b...
    MAY 22, 2018 08:00 AM PDT
    C.E. CREDITS
    MAY 22, 2018 08:00 AM PDT
    DATE: May 22, 2018TIME: 08:00AM PDT The nuclear receptors pregnane X receptor (PXR) and constitutive androstane receptor (CAR) are closely related transcription factors that...
    MAY 24, 2018 09:30 AM PDT
    C.E. CREDITS
    MAY 24, 2018 09:30 AM PDT
    DATE: May 24, 2018 TIME: 9:30PM PDT The current gold standard in in vitro pre-clinical cancer treatment screening remain cell lines,...
    JUN 26, 2018 06:00 AM PDT
    C.E. CREDITS
    JUN 26, 2018 06:00 AM PDT
    Date: June 26, 2018Time: 6:00 a.m. PDT, 9:00 a.m. EDT, 1500 CEST Today’s hematology analyzers employ various methods for enumerating platelets. These methods include: e...
    APR 27, 2018 10:00 AM PDT
    C.E. CREDITS
    APR 27, 2018 10:00 AM PDT
    DATE: April 27, 2018TIME: 10:00am PST, 1:00pm ESTGlioblastoma (GBM) and Medulloblastoma (MB) are the most common adult and paediatric brain tumours, both of which can have devastating c...
    Loading Comments...