从直接口服抗凝剂(DOAC)过渡到肝素输注期间的抗凝监测是一个重大挑战。因子Xa抑制剂影响肝素校准的抗因子Xa测定。弗吉尼亚大学(UVA)医学中心在此过渡期内使用了校正的抗因子Xa测定(c-AXA),其去除DOAC介导的抗Xa因子活性(d-AXA)并反映肝素特异性活性。目前,这种影响的持续时间没有得到很好的描述。
这项研究有两个目的:确定初始d-AXA是否可以预测DOAC影响的持续时间,并进一步表征不同患者群体之间的这种影响。
这项回顾性研究包括2016年9月至2017年3月在UVA医学中心住院的成年患者,并进行了c-AXA测量。肝素开始前48小时内接受阿哌沙班或利伐沙班。皮尔逊相关检验,Kaplan-Meier生存分析,和多元线性回归用于评估初始d-AXA与影响持续时间之间的关系。
68例患者符合纳入标准,并在肝素开始前维持阿哌沙班(85%)或利伐沙班(15%)。初始d-AXA的范围为0.11至3.27IU/ml。平均影响时间为69.3±46.2小时,中位持续时间为62.7小时。在初始d-AXA和影响持续时间之间没有发现强相关性(R2=0.124)。相互作用药物的存在显着增加了影响的持续时间(p=0.012)。肾功能正常和动态肾功能患者的影响持续时间差异无统计学意义(p=0.84)。或体重指数(BMI)大于40kg/m2(p=0.16)。
最初的d-AXA不能预测从DOAC过渡到肝素输注的患者的影响持续时间;然而,影响的中位数持续时间表明影响可能存在的时间比文献中目前所述的时间更长,尤其是那些服用相互作用药物的人。
Anticoagulation monitoring during transition from direct oral anticoagulants (DOAC) to heparin infusions is a significant challenge. Factor Xa inhibitors influence the heparin calibrated antifactor Xa assay. The University of Virginia (UVA) Medical Center utilized a corrected antifactor Xa assay (c-AXA) during this transition period, which removes DOAC-mediated antifactor Xa activity (d-AXA) and reflects heparin-specific activity. Currently, the duration of this influence is not well described.
This study had two aims: to determine if the initial d-AXA is predictive of the duration of DOAC influence and to further characterize this influence among different patient populations.
This retrospective study included adult patients admitted to UVA Medical Center between September 2016 and March 2017, with c-AXA measurements, who received apixaban or rivaroxaban within 48 hours before heparin initiation. A Pearson correlation test, Kaplan-Meier Survival Analysis, and multivariate linear regression were used to assess the relationship between initial d-AXA and duration of influence.
Sixty-eight patients met inclusion criteria and were maintained on either apixaban (85%) or rivaroxaban (15%) before heparin initiation. The initial d-AXA ranged from 0.11 to 3.27 IU/ml. The mean duration of influence was 69.3 ± 46.2 hours, with a median duration of 62.7 hours. No strong correlation was identified between initial d-AXA and duration of influence (R2 = 0.124). Presence of interacting medications significantly increased duration of influence (p=0.012). No significant difference in duration of influence existed between patients with normal renal function and those with dynamic renal function (p=0.84), or with body mass index (BMI) greater than 40 kg/m2 (p=0.16).
The initial d-AXA was not predictive of duration of influence in patients transitioning from DOACs to heparin infusion; however, the median duration of influence suggests influence may be present for longer than currently stated in the literature, especially in those taking interacting medications.