Design and Implementation of an Anti-Factor Xa Heparin Monitoring Protocol.
Tanya Williams-Norwood, Megan Caswell, Barbara Milner and 6 others
PMID 32526007WHAT IT FOUND
In one hospital, 80% of patients monitored with a nurse-driven anti-Xa heparin protocol reached therapeutic anticoagulation within 24 hours, compared with 54% under the old aPTT protocol, and no major bleeding was reported.
Key findings
01In the anti-Xa protocol group, 80% of analyzed patients reached therapeutic anticoagulation within 24 hours, compared with 54% in the previous aPTT group.
02The anti-Xa protocol moved heparin dose calculations to the provider and pharmacy, so the order to nursing staff gave exact bolus volume and infusion rate.
03No major bleeding or heparin-induced thrombocytopenia occurred in all reviewed cases, and one minor bleeding event was documented.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-center quality improvement project, and the authors said a prospective randomized trial would be ideal to address clinical questions such as length of stay and safety endpoints. The comparison with the previous aPTT protocol used retrospective medical records from 604 patients, not concurrent randomized groups. Patients with left ventricular assist devices, heparin treatment for less than 24 hours, or treatment interrupted for more than 10 hours were excluded from the efficacy analysis. The paired aPTT and anti-Xa analysis was not part of the original study design and used 94 simultaneous tests. The protocol compliance review used 100 consecutive records, while the efficacy analysis used 178 patients, so the reported numbers describe different parts of the project.
Declared interests
The authors declared no conflicts of interest. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.
The easy way to misread this
Do not read the 80% versus 54% result as proof that anti-Xa monitoring causes better outcomes. This was a single-center before-and-after quality improvement, not a randomized trial, and excluded left ventricular assist device patients.