Portal de Periódicos da CAPES

Factors Influencing Anti-Xa Assays: A Multicenter Prospective Study in Critically Ill and Noncritically Ill Patients Receiving Unfractionated Heparin

2023; Thieme Medical Publishers (Germany); Volume: 123; Issue: 12 Linguagem: Inglês

10.1055/s-0043-1770096

2567-689X

Dominique Lasne, M. Toussaint‐Hacquard, Céline Delassasseigne, Anne Bauters, Claire Flaujac, Philippe Savard, C. Mouton, Emmanuel de Maistre, Alain Stépanian, Valérie Eschwège, Maxime Delrue, Jean‐Louis Georges, Antoine Gros, Alexandre Mansour, G Leroy, Romain Jouffroy, Matthieu Mattei, Antoine Beurton, Adeline Pontis, Marie Neuwirth, Fabienne Nédelec-Gac, Thomas Lecompte, Emmanuel Curis, Virginie Siguret, Isabelle Gouin‐Thibault,

Acute Myocardial Infarction Research

The presence of dextran sulfate (DS) in reagents and the type of blood collection tube (citrate/citrated-theophylline-adenosine-dipyridamole [CTAD]) can lead to discrepancies between unfractionated heparin (UFH) anti-Xa levels. To evaluate the extent of the effect (1) of different reagents containing or not containing DS and (2) of the blood collection tubes, on UFH anti-Xa levels, in various clinical situations (NCT04700670). We prospectively included patients from eight centers: group (G)1, cardiopulmonary bypass (CPB) after heparin neutralization (n = 39); G2, cardiothoracic intensive care unit (ICU) after CPB (n = 35); G3, medical ICU (n = 53); G4, other medical inpatients (n = 38). Blood was collected into citrated and CTAD tubes. Chromogenic anti-Xa assays were centrally performed, using seven reagent/analyzer combinations including two without DS. The association between anti-Xa levels and covariates was tested using a linear mixed-effects model. We analyzed 4,546 anti-Xa values from 165 patients. Median anti-Xa levels were systematically higher with reagents containing DS, whatever the patient group, with the greatest effect observed in G1 (0.32 vs. 0.05 IU/mL). Anti-Xa levels were slightly higher in CTAD than in citrate samples, irrespective of the assay. The model showed: (1) a significant dextran-patient group interaction (p < 0.0001), the effect of DS on anti-Xa levels varying from 30.9% in G4 to 296% in G1, and (2) a significant effect of CTAD, varying between patient groups (p = 0.0302). The variability of anti-Xa levels with a great overestimation of the values, using a reagent containing DS, can lead to different treatment decisions, especially after heparin neutralization by protamine. Clinical consequences of these differences remain to be demonstrated.