Issue: 2014 > July > original article

Accuracy of aPTT monitoring in critically ill patients treated with unfractionated heparin

S. van Roessel, S. Middeldorp, Y.W. Cheung, A.H. Zwinderman, A.C.J.M. de Pont


Introduction: The anticoagulant effect of unfractionated
heparin (UFH) is usually monitored by means of the
activated partial thromboplastin time (aPTT). In critically
ill patients, however, increased levels of acute phase
proteins may decrease the accuracy of the aPTT, leading
to inadequate UFH dosing. In these circumstances, the
anti-Xa assay is recommended for monitoring.
Objective: We aimed to analyse the accuracy of the aPTT
for the monitoring of UFH dosing in critically ill patients.
Methods: In critically ill patients treated with
therapeutic doses of UFH, we compared aPTT levels
with simultaneously measured anti-Xa levels as the gold
standard. Sensitivity and specificity of the aPTT were
determined for different cut-off points, receiver operating
characteristic (ROC) curves were constructed and their
areas under the curve (AUCs) were calculated. Results: A total of 171 paired blood samples from 58 patients
were analysed. Concordant aPTT and anti-Xa values were observed in 108 (63.2%) data pairs. In 33 data pairs (19.3%) the aPTT was discordantly high and in 30 data pairs (17.5%) discordantly low. The sensitivity of the aPTT in detecting UFH underdosing and overdosing was 0.63 and 0.37, respectively. When considering alternative thresholds, ROC curves for underdosing and overdosing had AUCs of 0.71 and 0.81, respectively.
Conclusion: In this small cohort of critically ill patients,
the aPTT was accurate in 63.2% of the blood samples. Its sensitivity to detect UFH underdosing and overdosing
was low (0.63 and 0.37, respectively). We conclude that in critically ill patients, the aPTT is not accurate enough to detect UFH underdosing and overdosing.