Skip to main content
  • Poster presentation
  • Open access
  • Published:

Bedside anti-Xa measurement for therapeutic assessment of a prophylactic anticoagulation regimen

Introduction

Dose adjustments of low molecular weight heparin (LMWH) based on daily anti-Xa measurement by chromogenic assay remain controversial in daily clinical practice. One of the major obstacles is the cost of such a test. An affordable and reliable bedside test could change practice to an individual tailored dosing of LMWH. The aim of our study was to evaluate whether a prophylactic dose regimen of 40 mg enoxaparine in cardiac surgical patients increases the anti-Xa activity to the level necessary for efficient prevention of a thromboembolic event [1]. Secondarily we tested whether there was a reliable correlation between a bedside anti-Xa measurement compared with a two-stage chromogenic assay at the laboratory [2].

Methods

This was an open, single-centre, prospective, nonrandomized clinical trial at a university hospital. All patients that needed prophylactic dosing of enoxaparine after cardiac surgery were duly informed and after giving written consent we included 44 patients with a mean Euroscore of 1.66. The demographic specifications, medical and surgical history of all patients were collected. Anti-Xa activity was measured at three different points in time. We determined baseline, peak and trough anti-Xa activity: preoperatively, and respectively 4 hours after the third dose of enoxaparine and 30 minutes before the fourth dose. Each measurement was done with both techniques, the two-stage chromogenic assay at the laboratory (Biophen®) and the bedside assay (Hemochron® Jr).

Results

Our dose regimen of enoxaparine achieved in one-half of the included patients a sufficient anti-Xa activity for prevention of thromboembolic events. One-half of the patients with insufficient anti-Xa activity had a body mass index over 30 kg/m2. Comparison of the bedside assay with the two-stage chromogenic assay by means of the Pearson's correlation coefficient showed correlation of the two tests if no variables were taken into account. In the Bland-Altman analysis we could not confirm this correlation.

Conclusion

The bedside anti-Xa activity assay with a Hemochron device tends to show some correlation with the two-stage chromogenic assay, but insufficient to be used as an alternative, in this small but uniform patient population. Use of a standard dosing protocol for enoxaparine administration is prone for underdosage in post-cardiac surgery patients and may increase postoperative morbidity.

References

  1. Ribic C, et al.: J Crit Care. 2009, 24: 197-205. 10.1016/j.jcrc.2008.11.002

    Article  CAS  PubMed  Google Scholar 

  2. Gehrie E, et al.: Am J Hematol. 2012, 87: 194-196. 10.1002/ajh.22222

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Dewulf, B., Herck, I., De Somer, F. et al. Bedside anti-Xa measurement for therapeutic assessment of a prophylactic anticoagulation regimen. Crit Care 17 (Suppl 2), P348 (2013). https://doi.org/10.1186/cc12286

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc12286

Keywords