title: Antifactor Xa Activity for the Management of Anticoagulation during Cardiac Surgery.
abstract: Background In patients with autoimmune diseases associated with antiphospholipid antibodies, precise management of anticoagulation during extracorporeal circulation (ECC) is complicated. It was the aim of the present study to determine whether antifactor Xa (aXa) activity is useful in guiding heparin therapy during ECC. Methods In 15 patients undergoing cardiac surgery, anticoagulation with unfractionated heparin (UFH) and its reversal with protamine were guided using activated clotting time (ACT) (>400 second during ECC; ≤100 second for UFH reversal). For each ACT, the corresponding aXa activity levels were measured. Results A total of 144 blood samples were obtained. ACT and aXa activity were significantly correlated (r = 0.771, p< 0.0001, Spearman rank-order correlation). Using receiver operating characteristic curve (ROC) analyses, the cutoffvalues for aXa activity were 1.14 IU/mL (area under the ROC curve [AUC]: 0.89; inaccuracy rate: 9.4%) to predict ACT > 400 seconds and 0.55 IU/mL (AUC: 0.85; inaccuracy rate: 13.3%) for ACT ≤ 100 seconds. Conclusion AXa activity is strongly correlated with ACT, and therefore may be feasible for managing anticoagulation with UFH during ECC.
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Reyher
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Claire
authors.initials: C
authors.lastname: Würfel
authors.affiliation: Division of Hemostaseology, Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Edelgard
authors.initials: E
authors.lastname: Lindhoff-Last
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.affiliation: Division of Hemostaseology, Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Schindewolf
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Christian Friedrich
authors.initials: CF
authors.lastname: Weber
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D019540:Area Under Curve; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D015951:Factor Xa / Q000276:immunology*; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006494:Heparin Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage* / Q000009:adverse effects; D012372:ROC Curve; D015203:Reproducibility of Results; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D001323:Autoantibodies; D015415:Biomarkers; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin; D015951:Factor Xa