The effect of instrumentation and laboratory site on the accuracy of the APTT-based heparin therapeutic range.
BACKGROUND
Monitoring of unfractionated heparin therapy by activated partial thromboplastin time using the ex vivo method for determining the heparin therapeutic range (HTR) is the standard of practice. Many extrinsic and intrinsic factors influence accuracy of the HTR. This study investigates the affect of instrumentation and laboratory site on the accuracy of the ex vivo HTR method.


METHODS
Patients on unfractionated heparin are used to determine the HTR by published guidelines. Various instruments and different laboratories are compared to investigate the affect of these variables on the HTR.


RESULTS
The HTR is the same when the same model of instrument or even different models (same methodology) are used in the same laboratory. However, a significant clinical difference is observed when different hospital laboratories using same lot and instrument model are compared.


CONCLUSIONS
The ex vivo method for HTR is the best protocol currently available. The HTR should be determined and averaged on all of the same method instruments used in the laboratory. However, determination of the HTR in different laboratories should not be shared.
Pathology and Laboratory Medicine Services, Oklahoma City VA Medical Center, Oklahoma City, OK, USA.|Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
R A
RA
Marlar
Pathology and Laboratory Medicine Services, Oklahoma City VA Medical Center, Oklahoma City, OK, USA.
J N
JN
Gausman
D000925:Anticoagulants / Q000097:blood / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards; D006493:Heparin / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D007755:Laboratories, Hospital; D010314:Partial Thromboplastin Time / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D012015:Reference Standards; D012016:Reference Values; D015203:Reproducibility of Results
D000925:Anticoagulants; D006493:Heparin