Application of anti-Xa assay in monitoring unfractionated heparin therapy in contemporary antithrombotic management. Issue 1 (2nd January 2023)

• Record Type: Journal Article
• Authors: Safani, Michael; Appleby, Steve; Chiu, Ryan; Favaloro, Emmanuel J; Ferro, Emanuel T.; Johannes, Jimmy; Sheth, Milan
• Is Part Of: Expert review of hematology. Volume 16:Issue 1(2023)
• Page Start: 1
• Page End: 8
• Publication Date: 2023-01-02
• Subjects: Activated partial thromboplastin time -- aPTT -- anticoagulation -- contemporary -- factor xa -- heparin -- monitoring -- thrombosis; Hematology -- Periodicals; 616.15005
• DOI: 10.1080/17474086.2023.2169126
• Languages: English
• ISSNs: 1747-4086

Abstract

ABSTRACT: Introduction: Unfractionated heparin remains the most widely used agent in the prevention and acute treatment of thrombosis. Pharmacological complexities of this intriguing agent mandate frequent monitoring of its anticoagulant properties to maintain safe and effective hematological outcomes. Although activated partial thromboplastin time has been the standard test to monitor unfractionated heparin therapy for many decades, the anti-Xa assay has emerged as a substitute or adjunct in many institutions. Areas covered: This brief report outlines the key features of anti-Xa assay in monitoring unfractionated heparin in acute management of thrombosis in various contemporary settings, with emphasis on evidence for clinical outcomes. PubMed.gov database was utilized to obtain the pertinent literature. Expert opinion: The anti-Xa activity is primarily a reflection of UFH concentration and does not account for other hematological variables frequently present in contemporary anticoagulation management. The advantage of the anti-Xa assay in monitoring UFH therapy is predicated upon its limitations to account for global physiological hemostasis. There are significant disease and drug interactions that may potentially result in false in-vitro analysis of anti-Xa activity. Routine application of the anti-Xa assay is not evidence-based at this time.