CONCENTRATION SERVICE COAGULATION DIAGNOSIS
ANALYZER REAGENTS APPLICATION
Proper monitoring of heparin drugs is both a science and an art, and is directly related to the success or failure of anticoagulant therapy.
Heparin drugs are commonly used anticoagulants for the prevention and treatment of thromboembolic diseases and are widely used in many clinical fields.
However, how to correctly use and reasonably monitor these drugs to ensure the safety and effectiveness of treatment has always been the focus of clinicians.
The recently released "Expert Consensus on Clinical Monitoring of Heparin Drugs" fully discussed the indications, dosage, monitoring and other aspects of heparin drugs, especially clarified the clinical application methods of laboratory indicators such as anti-Xa activity.
This article will summarize the key points of this consensus to help clinical workers better apply it in practice.
1-Selection of laboratory monitoring indicators
The consensus emphasizes that general items that should be monitored before and during the use of heparin drugs include but are not limited to hemodynamics, renal function, hemoglobin, platelet count and occult blood in stool.
2-Key points for monitoring different heparin drugs
(1) Unfractionated heparin (UFH)
Therapeutic dose of UFH must be monitored and the dose adjusted according to the anticoagulant activity.
ACT monitoring is used for high-dose use (such as during PCI and extracorporeal circulation [CPB]).
In other situations (such as the treatment of ACS or VTE), APTT corrected for anti-Xa or anti-Xa activity can be selected.
(2) Low molecular weight heparin (LMWH)
According to the pharmacokinetic characteristics of LMWH, routine monitoring of anti-Xa activity is not required.
However, patients with high or low body weight, pregnancy, or renal insufficiency need to undergo safety assessment or dose adjustment based on anti-Xa activity.
(3) Fondaparinux sodium monitoring
Patients using preventive or therapeutic doses of fondaparinux sodium do not need routine anti-Xa activity monitoring, but monitoring of anti-Xa activity is recommended in obese patients with renal insufficiency.
3- Heparin resistance and HIT treatment
When antithrombin (AT) deficiency or heparin resistance is suspected, it is recommended to test AT activity levels to exclude AT deficiency and guide necessary replacement therapy.
It is recommended to use a chromogenic substrate assay based on IIa (containing bovine thrombin) or Xa for AT activity.
For patients clinically suspected of heparin-induced thrombocytopenia (HIT), HIT antibody testing is generally not recommended for UFH-exposed patients with a low clinical probability of HIT (≤3 points) based on a 4T score.
For patients with an intermediate to high clinical probability of HIT (4-8 points), HIT antibody testing is recommended.
A higher threshold is recommended for mixed antibody testing, while a lower threshold is recommended for IgG-specific antibody testing.
4- Bleeding Risk Management and Reversal Therapy
In the event of severe heparin-related bleeding, antithrombotic drugs should be discontinued immediately, and hemostasis and hemodynamic stability should be maintained as quickly as possible.
Protamine is recommended as a first-line treatment for neutralizing heparin.
The protamine dosage should be calculated based on the duration of heparin use.
While there are no specific monitoring methods for protamine, clinical evaluation of the reversal effect of protamine can be performed by observing the patient's bleeding status and changes in the APTT.
There is no specific antidote for fondaparinux sodium; its anticoagulant effects can be reversed using FFP, PCC, rFVIIa, and even plasma exchange.
This consensus provides detailed monitoring protocols and target values, helping us make more precise decisions in clinical practice.
Anticoagulant therapy is a double-edged sword: proper use can prevent and treat thrombotic disorders, but improper use can increase the risk of bleeding.
We hope that interpreting this consensus will help you become more effective in clinical practice and provide safer and more effective anticoagulant therapy for your patients.
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