Leana Mahmoud1, Andrew R Zullo2, Donald McKaig3, Christine M Berard-Collins4. 1. Neurocritical Care Specialist, Department of Pharmacy, Rhode Island Hospital, Providence, RI. 2. Investigator, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI; Clinical Pharmacist Specialist, Department of Pharmacy, Rhode Island Hospital, Providence, RI. 3. Medication Quality and Safety Specialist, Department of Pharmacy, Rhode Island Hospital, Providence, RI. 4. Director of Pharmacy, Rhode Island Hospital, The Miriam Hospital, and Bradley Hospital, Providence, RI.
Abstract
BACKGROUND: Activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) monitoring methods for unfractionated heparin (UFH) often disagree. The extent of discordance for those with elevated bilirubin remains unclear. Our objective was to evaluate concordance between activated aPTT and anti-Xa methods for hyperbilirubinemic patients on UFH. METHODS: This was a retrospective cohort study of 26 patients hospitalized at Rhode Island Hospital between August 2014 and September 2014. Patients had at least one bilirubin measurement >5 mg/dL. After categorizing lab values, percent agreement and kappa were used to examine concordance between aPTT and anti-Xa. RESULTS: Overall percent agreement between aPTT and anti-Xa was 50%. A nontherapeutic aPTT and therapeutic anti-Xa accounted for 98% of all disagreement. Specifically, 76.7% of disagreement was due to a subtherapeutic aPTT and a therapeutic anti-Xa. Unweighted kappa was 0.141 (95%CI: 0.048-0.235). CONCLUSION: Concordance between aPTT and anti-Xa values was poor in hyperbilirubinemic patients.
BACKGROUND: Activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) monitoring methods for unfractionated heparin (UFH) often disagree. The extent of discordance for those with elevated bilirubin remains unclear. Our objective was to evaluate concordance between activated aPTT and anti-Xa methods for hyperbilirubinemicpatients on UFH. METHODS: This was a retrospective cohort study of 26 patients hospitalized at Rhode Island Hospital between August 2014 and September 2014. Patients had at least one bilirubin measurement >5 mg/dL. After categorizing lab values, percent agreement and kappa were used to examine concordance between aPTT and anti-Xa. RESULTS: Overall percent agreement between aPTT and anti-Xa was 50%. A nontherapeutic aPTT and therapeutic anti-Xa accounted for 98% of all disagreement. Specifically, 76.7% of disagreement was due to a subtherapeutic aPTT and a therapeutic anti-Xa. Unweighted kappa was 0.141 (95%CI: 0.048-0.235). CONCLUSION: Concordance between aPTT and anti-Xa values was poor in hyperbilirubinemicpatients.
Authors: J D Olson; C F Arkin; J T Brandt; M T Cunningham; A Giles; J A Koepke; D L Witte Journal: Arch Pathol Lab Med Date: 1998-09 Impact factor: 5.534
Authors: Clifford M Takemoto; Michael B Streiff; Kenneth M Shermock; Peggy S Kraus; Junnan Chen; Jayesh Jani; Thomas Kickler Journal: Am J Clin Pathol Date: 2013-04 Impact factor: 2.493