The utility of thromboelastography in monitoring low molecular weight heparin therapy in the coronary care unit

White, Hayden, Sosnowski, Kellie, Bird, Robert, Jones, Mark and Solano, Connie (2012) The utility of thromboelastography in monitoring low molecular weight heparin therapy in the coronary care unit. Blood Coagulation & Fibrinolysis, 23 4: 304-310. doi:10.1097/MBC.0b013e32835274c0

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Author White, Hayden
Sosnowski, Kellie
Bird, Robert
Jones, Mark
Solano, Connie
Title The utility of thromboelastography in monitoring low molecular weight heparin therapy in the coronary care unit
Journal name Blood Coagulation & Fibrinolysis   Check publisher's open access policy
ISSN 0957-5235
1473-5733
Publication date 2012-06-01
Sub-type Article (original research)
DOI 10.1097/MBC.0b013e32835274c0
Volume 23
Issue 4
Start page 304
End page 310
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Collection year 2013
Language eng
Formatted abstract
Low molecular weight heparins (LMWHs) are used for prevention and management of vascular thrombosis. In general, monitoring of anticoagulant activity is not required, however, certain populations may be susceptible to overdosing or underdosing. As anti-activated factor X(anti-Xa) activity testing is not readily available, it was our aim to investigate the usefulness of thromboelastography (TEG;Haemoscope Corporation, Skokie, Illinois, USA) for the assessment of coagulation in patients on LMWH. All patientsadmitted to the coronary care unit on therapeutic dose of enoxaparin were included (1 mg/kg twice daily). Blood samples were collected 4 h after the morning dose of enoxaparin once the participant had received at least three doses. When anti-Xa activity was classified as low (0–0.5), correct (0.5–1.0) or high (>1.0), the distribution of reaction time (R) and dose per kg showed little association with anti-Xa activity. The difference between mean R for the high anti-Xa group and the correct anti-Xa group was statistically nonsignificant using two-sample t-test (P=0.26). A linear regression model showed no evidence of association between dose per kg and anti-Xa (P=0.95). However, there was evidence of positive association between dose per kg and R (P=0.011) wherein a 10% increase in dose per kg was associated with an increase in R of 2.7 (95% confidence interval 0.6–4.7). There was no evidence of association between R and anti-Xa (P=0.38). TEG was unable to be used to predict anti-Xa activity. However, TEG R was prolonged in more than 90% patients and correlated with dose of enoxaparin. As enoxaparin dose correlated poorly with anti-Xa activity, a more global test might be necessary to adjust dosing of LMWH in sick, hospitalized patients.
Keyword Enoxaparin
Low Molecular Weight Heparin
Thromboelastography
Antifactor-Xa Activity
Deep-Vein Thrombosis
Anti-Factor Xa
Unfractionated Heparin
Whole-Blood
Plasma-Levels
Tissue Factor
Enoxaparin
Thrombelastography
Coagulation
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Public Health Publications
School of Medicine Publications
 
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Created: Tue, 05 Jun 2012, 13:32:39 EST by System User on behalf of School of Public Health