Concordance between Activated Partial Thromboplastin Time and Antifactor Xa Assay for Monitoring Unfractionated Heparin in Hospitalized Hyperbilirubinemic Patients

R I Med J (2013). 2016 Mar 1;99(3):33-7.

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.

Keywords: Activated partial thromboplastin time; Rhode Island; antifactor Xa heparin assay; hyperbilirubinemia; unfractionated heparin.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use*
  • Bilirubin / metabolism
  • Factor Xa Inhibitors / metabolism
  • Factor Xa Inhibitors / therapeutic use*
  • Female
  • Heparin / therapeutic use*
  • Humans
  • Hyperbilirubinemia / blood*
  • Male
  • Middle Aged
  • Partial Thromboplastin Time
  • Retrospective Studies
  • Young Adult

Substances

  • Anticoagulants
  • Factor Xa Inhibitors
  • Heparin
  • Bilirubin