Journal of thrombosis and haemostasis : JTH · 2025
Discrepancy between parallel anti-Xa and activated partial thromboplastin time is related to mortality in patients with Impella-supported cardiogenic shock.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Van Edom Charlotte J, Fiorelli Francesca, Balthazar Tim, Monteagudo-Vela Maria, Vanassche Thomas, Panoulas Vasileios F, Vandenbriele Christophe
Аннотация
BACKGROUND: Managing unfractionated heparin (UFH) during percutaneous mechanical circulatory support for cardiogenic shock (CS) is challenging due to potential discrepancies between coagulation tests.
OBJECTIVES: To study the causes and consequences of discrepancies between anti-Xa and activated partial thromboplastin time (APTT) for UFH monitoring during microaxial flow pump support (Impella) for CS.
METHODS: We assessed patients in CS supported with Impella in 2 tertiary care centers over 62 months. UFH was titrated based on anti-Xa levels with parallel APTT measurements. In-range anti-Xa levels were considered between 0.20 and 0.30 IU/mL or 0.31 and 0.50IU/mL, and the corresponding APTT values were 40 to 55 seconds and 56 to 80 seconds, respectively. Pearson correlation was calculated between anti-Xa and APTT. Samples with in-range anti-Xa but prolonged APTT were analyzed for abnormalities in international normalized ratio (INR; ≥1.5) and/or fibrinogen (<1.5g/L). Mortality during Impella support was then compared in those with and without additional coagulation abnormalities (chi-squared test).
RESULTS: Correlation between anti-Xa and APTT was weak (r = 0.50, P < .001, N = 2447). When anti-Xa was in range (N = 1914 samples), 24% had short, 52% had in-range, and 24% had prolonged APTT. Of the 57 patients with prolonged APTT, 28 had abnormal same-day INR and/or fibrinogen, whereas 29 had normal fibrinogen and INR. Mortality was higher in patients with abnormal INR and/or fibrinogen than in those with normal fibrinogen and INR (32% vs 10%; P = .043).
CONCLUSION: Anti-Xa/APTT discrepancies are frequent during percutaneous mechanical circulatory support for CS, highlighting the importance of a multiple testing strategy. Outcomes of patients with prolonged APTT were related to the presence of abnormal INR and/or fibrinogen, suggesting a serious concomitant underlying disease.
OBJECTIVES: To study the causes and consequences of discrepancies between anti-Xa and activated partial thromboplastin time (APTT) for UFH monitoring during microaxial flow pump support (Impella) for CS.
METHODS: We assessed patients in CS supported with Impella in 2 tertiary care centers over 62 months. UFH was titrated based on anti-Xa levels with parallel APTT measurements. In-range anti-Xa levels were considered between 0.20 and 0.30 IU/mL or 0.31 and 0.50IU/mL, and the corresponding APTT values were 40 to 55 seconds and 56 to 80 seconds, respectively. Pearson correlation was calculated between anti-Xa and APTT. Samples with in-range anti-Xa but prolonged APTT were analyzed for abnormalities in international normalized ratio (INR; ≥1.5) and/or fibrinogen (<1.5g/L). Mortality during Impella support was then compared in those with and without additional coagulation abnormalities (chi-squared test).
RESULTS: Correlation between anti-Xa and APTT was weak (r = 0.50, P < .001, N = 2447). When anti-Xa was in range (N = 1914 samples), 24% had short, 52% had in-range, and 24% had prolonged APTT. Of the 57 patients with prolonged APTT, 28 had abnormal same-day INR and/or fibrinogen, whereas 29 had normal fibrinogen and INR. Mortality was higher in patients with abnormal INR and/or fibrinogen than in those with normal fibrinogen and INR (32% vs 10%; P = .043).
CONCLUSION: Anti-Xa/APTT discrepancies are frequent during percutaneous mechanical circulatory support for CS, highlighting the importance of a multiple testing strategy. Outcomes of patients with prolonged APTT were related to the presence of abnormal INR and/or fibrinogen, suggesting a serious concomitant underlying disease.