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    Anti Factor Xa Level 2021 Education

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    Tom Biuso

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    Anti Factor Xa Level 2021 Education

    Uploaded by

    Tom Biuso
    2 views1 page

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    Anti Factor Xa level 2021 Education

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    2 views1 page

    Anti Factor Xa Level 2021 Education

    Uploaded by

    Tom Biuso

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Anti-Xa Monitoring to replace aPTT in heparin drips

    Since May 2020 TMC has been processing Antifactor-Xa (Af-Xa) levels Monday to Friday
    from 0700-1500. Starting this summer, 2021 TMC will start processing them 24/7.

    There are 2 separate orders (with different goal ranges)


    • Unfractionated: for measuring effects of HEPARIN
    o Goal of 0.3-0.7 for TREATMENT of VTE
    o Goal of 0.3-0.5 for bleeding risks, ACS, MI, stroke, thrombolytics
    o Goal of 0.1-0.4 for VTE PROPHYLAXIS
    • Low Molecular Weight: for measuring effects of ENOXAPARIN (LOVENOX)
    o Goal of 0.5-1.2 for TREATMENT of VTE
    o Goal of 0.2-0.5 for VTE PROPHYLAXIS

    No need to draw aPTT at the same time (there will be a DUPLICATE warning that will alert)
    • DOACs may elevate the Xa levels and may need to monitor aPTT until DOAC out of the system

    Anti-Xa levels are more expensive than aPTTs and should be used when necessary
    Benefits of Anti-Xa levels
    • More specific and less variable measurement for monitoring effects of heparin compared to aPTT
    o Less adjustments and lab draws in heparin drips – better staff and patient satisfaction
    o Less SUBtherapeutic levels – faster and better control of disease/condition
    o Less SUPRAtherapeutic levels – less bleeding complications and blood transfusions
    • Good for monitoring patients with known prolonged aPTT (lupus anticoagulant, liver disease, meds, etc.)

    Limitations of Anti-Xa levels


    • Not approved for fondaparinux, argatroban or DOAC monitoring
    For heparin – will be added to heparin drip order set: drawn Q6H until therapeutic x 2, then daily
    For enoxaparin – not for routine use, consider with severe organ dysfunction, extremely low body weight,
    pediatrics
    • Typically drawn after 3rd/4th dose when at steady state, 4-6 hours after dose given
    Continue to use aPTT monitoring for (but not limited to)
    • Argatroban dosing/monitoring (until there is an approved anti-Xa test)
    • Evaluation of unexplained bleeding/coagulopathies (i.e. Rattlesnake bites)
    • Diagnosing disseminated intravascular coagulation (DIC)

    References:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715846
    https://pubmed.ncbi.nlm.nih.gov/27543785
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278066

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