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Change to anti-Xa from APTT in heparin monitoring: clinical benefits

Recent developments in anti-Xa technology have resulted in a coagulation test that can easily be part of the core coagulation laboratory repertoire. Here, Stago compares and contrasts two methods for monitoring heparin therapy.

The arrival of COVID-19 has accelerated a trend in the NHS away from reliance on activated partial thromboplastin time (APTT) to assess a patient’s unfractionated heparin (UFH) concentration. The fundamental issue is that it may not accurately measure the amount of heparin present.

            Like all drugs, UFH must be administered in the right amount to ensure that its intended clinical effect is achieved, while avoiding adverse effects. The properties of the test used to monitor the therapeutic window can have a significant impact on the quality of care received by the patient.

            As APTT is a non-specific surrogate marker, it can only estimate heparin concentration. Many factors may influence the result, such as variations in potency of each batch of UFH and differences between patient responses. These can vary even with the same patient at different times during the day. It is therefore possible to both underestimate and overestimate heparin levels with the APTT, risking both bleeding and thrombosis.1

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