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Editorial| Volume 218, P199-200, October 2022

To aPTT or not to aPTT: Evaluating the optimal monitoring strategy for unfractionated heparin

Published:November 21, 2021DOI:https://doi.org/10.1016/j.thromres.2021.11.012
      Anticoagulation is widely used in the inpatient setting for various indications for both surgical and medical patients including stroke prevention in non-valvular atrial fibrillation, prevention of venous thromboembolism in post-surgical patients, management of acute coronary syndromes, and treatment of acute thrombosis. For patients with acute thrombosis, anticoagulation is the key therapy to stabilize the thrombus, prevent extension, and to prevent development of new thrombosis while risk factors are present [
      • Ortel T.L.
      • Neumann I.
      • Ageno W.
      • et al.
      American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism.
      ]. Despite an expanding repertoire of anticoagulation options (including low molecular weight heparin, oral Xa inhibitors, and intravenous and oral direct thrombin inhibitors), intravenous unfractionated heparin (IV UFH) continues to have significant use in the inpatient setting. Due to its variable pharmacokinetics and pharmacodynamics, monitoring and dose titration of IV UFH is required and has been primarily accomplished with use of the activated partial thromboplastin time (aPTT), although many institutions are increasingly using the anti-Xa [
      • Hylek E.M.
      • Regan S.
      • Henault L.E.
      • et al.
      Challenges to the effective use of unfractionated heparin in the hospitalized management of acute thrombosis.
      ].

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