 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 July 1993 | Volume 119 Issue 2 | Pages 104-109
Objective: To compare two methods of determining a therapeutic range of activated partial thromboplastin time (aPT) results.
Design: Cohort studies.
Setting: Referral teaching hospital.
Patients: Inpatients who received unfractionated heparin intravenously for venous thromboembolic disease.
Measurements: A therapeutic range determined by aPT ratios of 1.5 to 2.5 times the control value as compared with a therapeutic range determined by protamine titration heparin levels of 0.2 to 0.4 U/mL.
Results: For all aPT reagents studied, a ratio of 1.5 times the control value is much less than a minimum protamine titration heparin level of 0.2 U/mL. Various manufacturers' aPT reagents and reagent lots from the same manufacturer show considerable variation in response to heparin and therefore have different therapeutic ranges.
Conclusions: A different dose of heparin would be required to produce an aPT ratio of 1.5 times the control value, depending on the reagent used. Establishing a therapeutic range for aPT results using protamine titration heparin levels of 0.2 to 0.4 U/mL as a reference standard is practical and compensates for the variable response of aPT reagents to heparin.
Author and Article Information
From McMaster University Medical Center and Hamilton Civic Hospitals Research Centre, Hamilton, Ontario, Canada.
ARTICLE
Establishing a Therapeutic Range for Heparin Therapy
Requests for Reprints: Dr. P. Brill-Edwards, MD, McMaster University Medical Center, 1200 Main Street West, HSC-3W12, Hamilton, Ontario L8N 3Z5, Canada.
Acknowledgments: The authors thank Dianne Donovan, RN, Robin Roberts, PhD, and David Sackett, MD, for their contributions to and support of this study.
Grant Support: Dr. Ginsberg is the recipient of a Research Scholarship of the Heart and Stroke Foundation of Canada. Dr. Hirsh is a Distinguished Research Professor of the Heart and Stroke Foundation of Canada and a Trillium Award Recipient of the Ministry of Health.
This article has been cited by other articles:
|
|
 |
|
  J. Hirsh, K. A. Bauer, M. B. Donati, M. Gould, M. M. Samama, and J. I. Weitz Parenteral Anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 141S - 159S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 708S - 775S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Mousa, F. Zhang, A. Aljada, S. Chaturvedi, M. Takieddin, H. Zhang, L. Chi, M. C. Castelli, K. Friedman, M. M. Goldberg, et al. Pharmacokinetics and Pharmacodynamics of Oral Heparin Solid Dosage Form in Healthy Human Subjects J. Clin. Pharmacol., December 1, 2007; 47(12): 1508 - 1520. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kuhle, P. Eulmesekian, B. Kavanagh, P. Massicotte, P. Vegh, A. Lau, and L. G. Mitchell Lack of correlation between heparin dose and standard clinical monitoring tests in treatment with unfractionated heparin in critically III children Haematologica, April 1, 2007; 92(4): 554 - 557. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Tremey, B. Szekely, S. Schlumberger, D. Francois, N. Liu, K. Sievert, and M. Fischler Anticoagulation monitoring during vascular surgery: accuracy of the Hemochron(R) low range activated clotting time (ACT-LR) Br. J. Anaesth., October 1, 2006; 97(4): 453 - 459. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Prandoni How I treat venous thromboembolism in patients with cancer Blood, December 15, 2005; 106(13): 4027 - 4033. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. R. Hetzel and C. Sucker The heparins: all a nephrologist should know Nephrol. Dial. Transplant., October 1, 2005; 20(10): 2036 - 2042. [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Bates and J. I. Weitz Coagulation Assays Circulation, July 26, 2005; 112(4): e53 - e60. [Full Text] [PDF]
|
|
|
|
 |
|
 S. A Spinler, A. K Wittkowsky, E. A Nutescu, and M. A Smythe Anticoagulation Monitoring Part 2: Unfractionated Heparin and Low-Molecular-Weight Heparin Ann. Pharmacother., July 1, 2005; 39(7): 1275 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. McGuire and P. P. Dobesh Therapeutic Update on the Prevention and Treatment of Venous Thromboembolism Journal of Pharmacy Practice, October 1, 2004; 17(5): 289 - 307. [Abstract] [PDF]
|
|
|
|
|
|
M. A. Smythe and A. Caffee Anticoagulation Monitoring Journal of Pharmacy Practice, October 1, 2004; 17(5): 317 - 326. [Abstract] [PDF]
|
|
|
|
|
|
J. Hirsh and R. Raschke Heparin and Low-Molecular-Weight Heparin: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 188S - 203S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Buller, G. Agnelli, R. D. Hull, T. M. Hyers, M. H. Prins, and G. E. Raskob Antithrombotic Therapy for Venous Thromboembolic Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 401S - 428S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Menon, R. A. Harrington, J. S. Hochman, C. P. Cannon, S. D. Goodman, R. G. Wilcox, H. J. Schunemann, and E. M. Ohman Thrombolysis and Adjunctive Therapy in Acute Myocardial Infarction: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 549S - 575S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Bates, I. A. Greer, J. Hirsh, and J. S. Ginsberg Use of Antithrombotic Agents During Pregnancy: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 627S - 644S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C Gosselin, J. H King, K. A Janatpour, W. E Dager, E. C Larkin, and J. T Owings Comparing Direct Thrombin Inhibitors Using aPTT, Ecarin Clotting Times, and Thrombin Inhibitor Management Testing Ann. Pharmacother., September 1, 2004; 38(9): 1383 - 1388. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. McRae and J. S. Ginsberg Initial Treatment of Venous Thromboembolism Circulation, August 31, 2004; 110(9_suppl_1): I-3 - I-9. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Montalescot, J.P. Collet, M.L. Tanguy, A. Ankri, L. Payot, R. Dumaine, R. Choussat, F. Beygui, V. Gallois, and D. Thomas Anti-Xa Activity Relates to Survival and Efficacy in Unselected Acute Coronary Syndrome Patients Treated With Enoxaparin Circulation, July 27, 2004; 110(4): 392 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Anand, S. Yusuf, J. Pogue, J. S. Ginsberg, and J. Hirsh Relationship of Activated Partial Thromboplastin Time to Coronary Events and Bleeding in Patients With Acute Coronary Syndromes Who Receive Heparin Circulation, June 17, 2003; 107(23): 2884 - 2888. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Raschke, J. Hirsh, and J. R. Guidry Suboptimal Monitoring and Dosing of Unfractionated Heparin in Comparative Studies with Low-Molecular-Weight Heparin Ann Intern Med, May 6, 2003; 138(9): 720 - 723. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Ginsberg, W. S. Chan, S. M. Bates, and S. Kaatz Anticoagulation of Pregnant Women With Mechanical Heart Valves Arch Intern Med, March 24, 2003; 163(6): 694 - 698. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. G. DeLoughery Thrombocytopenia in Critical Care Patients J Intensive Care Med, November 1, 2002; 17(6): 267 - 282. [Abstract] [PDF]
|
|
|
|
 |
|
 A. A.M. Al-Lawati, M. Venkitraman, T. Al-Delaime, and J. Valliathu Pregnancy and mechanical heart valves replacement; dilemma of anticoagulation Eur. J. Cardiothorac. Surg., August 1, 2002; 22(2): 223 - 227. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. P. R. Walker and D. Royston Thrombin generation and its inhibition: a review of the scientific basis and mechanism of action of anticoagulant therapies Br. J. Anaesth., June 1, 2002; 88(6): 848 - 863. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hirsh, S. S. Anand, J. L. Halperin, and V. Fuster Guide to Anticoagulant Therapy: Heparin : A Statement for Healthcare Professionals From the American Heart Association Arterioscler. Thromb. Vasc. Biol., July 1, 2001; 21 (7): e9 - e9. [Full Text] [PDF]
|
|
|
|
|
|
J. Hirsh, S. S. Anand, J. L. Halperin, and V. Fuster Guide to Anticoagulant Therapy: Heparin : A Statement for Healthcare Professionals From the American Heart Association Circulation, June 19, 2001; 103(24): 2994 - 3018. [Full Text] [PDF]
|
|
|
|
 |
|
 T. M. Ambrose, C. A. Parvin, E. Mendeloff, and L. Luchtman-Jones Evaluation of the TAS Analyzer and the Low-Range Heparin Management Test in Patients Undergoing Extracorporeal Membrane Oxygenation Clin. Chem., May 1, 2001; 47(5): 858 - 866. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Bates, J. I. Weitz, M. Johnston, J. Hirsh, and J. S. Ginsberg Use of a Fixed Activated Partial Thromboplastin Time Ratio to Establish a Therapeutic Range for Unfractionated Heparin Arch Intern Med, February 12, 2001; 161(3): 385 - 391. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hirsh, T. E. Warkentin, S. G. Shaughnessy, S. S. Anand, J. L. Halperin, R. Raschke, C. Granger, E. M. Ohman, and J. E. Dalen Heparin and Low-Molecular-Weight Heparin Mechanisms of Action, Pharmacokinetics, Dosing, Monitoring, Efficacy, and Safety Chest, January 1, 2001; 119(1_suppl): 64S - 94S. [Full Text] [PDF]
|
|
|
|
|
|
J. S. Ginsberg, I. Greer, and J. Hirsh Use of Antithrombotic Agents During Pregnancy Chest, January 1, 2001; 119(1_suppl): 122S - 131S. [Full Text] [PDF]
|
|
|
|
|
|
T. M. Hyers, G. Agnelli, R. D. Hull, T. A. Morris, M. Samama, V. Tapson, and J. G. Weg Antithrombotic Therapy for Venous Thromboembolic Disease Chest, January 1, 2001; 119(1_suppl): 176S - 193S. [Full Text] [PDF]
|
|
|
|
|
|
E. M. Ohman, R. A. Harrington, C. P. Cannon, G. Agnelli, J. A. Cairns, and J.W. Kennedy Intravenous Thrombolysis in Acute Myocardial Infarction Chest, January 1, 2001; 119(1_suppl): 253S - 277S. [Full Text] [PDF]
|
|
|
|
 |
|
 C. H. Mielke JR, C. M. Starr, J. C. Klock, D. Devereaux, M. R. Mielke, D. E. Baker, L. Broemeling, M. Wacksman, J. R. White JR, S. A. Oliver, et al. Direct Measurement of Unfractionated Heparin Using a Biochemical Assay Clinical and Applied Thrombosis/Hemostasis, October 1, 1999; 5(4): 267 - 276. [Abstract] [PDF]
|
|
|
|
|
|
H. L. Messmore Jr, R. Kundur, W. Wehrmacher, and P. Scanlon Anticoagulant Therapy of Pregnant Patients with Prosthetic Heart Valves : Rationale for a Clinical Trial of Low Molecular Weight Heparin Clinical and Applied Thrombosis/Hemostasis, April 1, 1999; 5(2): 73 - 77. [Abstract] [PDF]
|
|
|
|
|
|
R. A. Baughman, S. C. Kapoor, R. K. Agarwal, J. Kisicki, F. Catella-Lawson, and G. A. FitzGerald Oral Delivery of Anticoagulant Doses of Heparin : A Randomized, Double-Blind, Controlled Study in Humans Circulation, October 20, 1998; 98(16): 1610 - 1615. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Mungall, B. A. Baker, and M. D. Adelman Activated Partial Thromboplastin Time vs Heparin Concentration Arch Intern Med, June 8, 1998; 158(11): 1273 - 1275. [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon, M. Johnston, K. Moffat, J. McGinnis, and J. S. Ginsberg Effect of Warfarin on Activated Partial Thromboplastin Time in Patients Receiving Heparin Arch Intern Med, May 25, 1998; 158(10): 1140 - 1143. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Kearon, B. A. Baker, M. D. Adelman, A. Krulewitz, A. H. Goodall, C. Knight, M. Cohen, and P. W. Armstrong Low-Molecular-Weight Heparin versus Unfractionated Heparin for Unstable Coronary Disease N. Engl. J. Med., January 8, 1998; 338(2): 129 - 131. [Full Text]
|
|
|
|
|
|
C. Eby Standardization of APTT Reagents for Heparin Therapy Monitoring: Urgent or Fading Priority? Clin. Chem., July 1, 1997; 43(7): 1105 - 1107. [Full Text] [PDF]
|
|
|
|
|
|
A. M. H. P. van den Besselaar, J. Neuteboom, J. Meeuwisse-Braun, and R. M. Bertina Preparation of lyophilized partial thromboplastin time reagent composed of synthetic phospholipids: usefulness for monitoring heparin therapy Clin. Chem., July 1, 1997; 43(7): 1215 - 1222. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Ginsberg Management of Venous Thromboembolism N. Engl. J. Med., December 12, 1996; 335(24): 1816 - 1829. [Full Text] [PDF]
|
|
|
|
|
|
J. Hirsh and J. Hoak Management of Deep Vein Thrombosis and Pulmonary Embolism : A Statement for Healthcare Professionals From the Council on Thrombosis (in Consultation With the Council on Cardiovascular Radiology), American Heart Association Circulation, June 15, 1996; 93(12): 2212 - 2245. [Full Text]
|
|
|
|
|
|
C. B. Granger, J. Hirsh, R. M. Califf, J. Col, H. D. White, A. Betriu, L. H. Woodlief, K. L. Lee, E. G. Bovill, R. J. Simes, et al. Activated Partial Thromboplastin Time and Outcome After Thrombolytic Therapy for Acute Myocardial Infarction : Results From the GUSTO-I Trial Circulation, March 1, 1996; 93(5): 870 - 878. [Abstract] [Full Text]
|
|
Article
