Abstract：
BACKGROUND: The monitoring of unfractionated heparin (UFH) by anti-factor Xa activity (AXA) is commonly used to ensure effective anticoagulation and prevent bleeding risk. However, in patients previously treated with an anti-Xa direct oral anticoagulant (DOAC) switching to UFH therapy, there is a risk of interference that may lead to inappropriate anticoagulation. The first objective of this study was to validate DOAC-Remove to remove DOAC for measuring UFH specific AXA. The second objective was to assess the length of DOAC interference on UFH monitoring and to identify potential predictive factors.
METHODS: This monocentric retrospective study included all patients admitted from April 2019 to April 2021 previously treated with anti-Xa DOAC, and for whom an interference on UFH monitoring was suspected. Interference was defined as a difference in the AXA measured before and after using DOAC-Remove >2.8-fold standard deviation of the method.
RESULTS: Removal with DOAC-Remove was specific of DOAC (apixaban n = 42, rivaroxaban n = 41, UFH n = 20) and sufficient to avoid interference on UFH AXA measurement. The exact interference length was 6.0 days [IQR 3.0-11.0] for apixaban (n = 26) and 4.5 days [IQR 2.0-5.8] for rivaroxaban (n = 20). Among the 89 patients sorted based on an interference length ≤ or >3 days, 74 (83.1%) presented an interference greater than 3 days. Correlations were observed with age for apixaban and creatinine for rivaroxaban.
CONCLUSIONS: Our results suggest that DOAC-Remove could be of high interest in patients receiving UFH previously treated with an anti-Xa DOAC even if DOAC was stopped for more than 3 days.
METHODS: This monocentric retrospective study included all patients admitted from April 2019 to April 2021 previously treated with anti-Xa DOAC, and for whom an interference on UFH monitoring was suspected. Interference was defined as a difference in the AXA measured before and after using DOAC-Remove >2.8-fold standard deviation of the method.
RESULTS: Removal with DOAC-Remove was specific of DOAC (apixaban n = 42, rivaroxaban n = 41, UFH n = 20) and sufficient to avoid interference on UFH AXA measurement. The exact interference length was 6.0 days [IQR 3.0-11.0] for apixaban (n = 26) and 4.5 days [IQR 2.0-5.8] for rivaroxaban (n = 20). Among the 89 patients sorted based on an interference length ≤ or >3 days, 74 (83.1%) presented an interference greater than 3 days. Correlations were observed with age for apixaban and creatinine for rivaroxaban.
CONCLUSIONS: Our results suggest that DOAC-Remove could be of high interest in patients receiving UFH previously treated with an anti-Xa DOAC even if DOAC was stopped for more than 3 days.
摘要：
背景：通过抗因子Xa活性（AXA）监测普通肝素（UFH）通常用于确保有效的抗凝和预防出血风险。然而,在以前接受抗Xa直接口服抗凝剂（DOAC）治疗的患者中，转换为UFH治疗，存在可能导致抗凝不当的干扰风险.本研究的第一个目的是验证DOAC-Remove以去除DOAC用于测量UFH特异性AXA。第二个目标是评估DOAC干扰对UFH监测的长度，并确定潜在的预测因素。
方法：这项单中心回顾性研究包括2019年4月至2021年4月之前接受过抗XaDOAC治疗的所有患者，怀疑对UFH监测有干扰。干扰定义为在使用DOAC-Remove之前和之后测量的AXA的差异>方法的2.8倍标准偏差。
结果：使用DOAC-Remove对DOAC具有特异性（阿哌沙班n=42，利伐沙班n=41，UFHn=20），足以避免对UFHAXA测量的干扰。阿哌沙班（n=26）的确切干扰时间为6.0天[IQR3.0-11.0]，利伐沙班（n=20）的确切干扰时间为4.5天[IQR2.0-5.8]。在根据干扰长度≤或>3天排序的89名患者中，74(83.1%)呈现大于3天的干扰。观察到阿哌沙班和利伐沙班的肌酐与年龄的相关性。
结论：我们的结果表明，DOAC-Remove对于之前接受抗XaDOAC治疗的UFH患者可能非常感兴趣，即使DOAC停用超过3天。
方法：这项单中心回顾性研究包括2019年4月至2021年4月之前接受过抗XaDOAC治疗的所有患者，怀疑对UFH监测有干扰。干扰定义为在使用DOAC-Remove之前和之后测量的AXA的差异>方法的2.8倍标准偏差。
结果：使用DOAC-Remove对DOAC具有特异性（阿哌沙班n=42，利伐沙班n=41，UFHn=20），足以避免对UFHAXA测量的干扰。阿哌沙班（n=26）的确切干扰时间为6.0天[IQR3.0-11.0]，利伐沙班（n=20）的确切干扰时间为4.5天[IQR2.0-5.8]。在根据干扰长度≤或>3天排序的89名患者中，74(83.1%)呈现大于3天的干扰。观察到阿哌沙班和利伐沙班的肌酐与年龄的相关性。
结论：我们的结果表明，DOAC-Remove对于之前接受抗XaDOAC治疗的UFH患者可能非常感兴趣，即使DOAC停用超过3天。
