| Laboratory considerations on DOAC levels (including precision and what we've learned from external QA; comment on andexanet) Jim Zehnder. |
Abstract
A robust correlation between aPTT and anti-Xa assays for unfractionated heparin therapeutic monitoring is generally expected in patients with normal hemostasis. However, in the presence of other comorbidities present in hospitalized patients, this relationship is poor. Of note, the discordant pattern of high aPTT to anti-Xa served is an independent predictor of 30-day all-cause mortality, with a higher degree of discordance associated with increased odds of 30-day mortality. The strengths and limitations of monitoring strategies will be discussed. In the absence of prospective data validating a particular monitoring strategy, obtaining baseline coagulation studies (aPTT, anti-Xa, and PT/INR) before initiating heparin therapy, followed by subsequent paired aPTT and anti-Xa measurements can identify this group of patients with high all-cause mortality and presents an opportunity to use these tests to individualize care of these patients based on their presentation and risks of bleeding and thrombosis.
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