Results of an international survey (ISTH) on the management of therapeutic-intensity unfractionated heparin
Notice bibliographique
Résumé
Introduction: Unfractionated heparin (UFH) remains the anticoagulant of choice for critically ill patients (parenteral administration, short-acting, readily reversible, low renal excretion). However, many key issues about laboratory monitoring and management are far from resolved. Initial dosing and adjustments are based on limited data. Close monitoring of UFH levels is mandatory, but there is still no consensus on the optimal approach. Furthermore, the therapeutic target is mostly based on experience, rather than on evidence. Method: Between November 2023 and February 2024, we conducted a cross-sectional online survey among International Society on Thrombosis and Haemostasis (ISTH) members involved in the management of patients receiving therapeutic-intensity UFH, under the aegis of the ISTH SSC Subcommittees on Control of Anticoagulation and Perioperative and Critical Care Thrombosis and Hemostasis. Our objective was to describe current practices and variations among centers, as reported by the respondents. Results: Of the 142 respondents from 15 countries around the world, 69% were physicians and 31% were laboratory medicine specialists. Therapeutic UFH was administered mainly for acute venous thromboembolism (n=74), mechanical circulatory support (n=74), mechanical heart valves (n=57), acute limb ischemia (n=54), atrial fibrillation (n=38), and acute coronary syndrome (n=37). Most respondents (85%) used citrate tubes to collect blood samples. UFH monitoring was based on an anti-Xa assay among 54% of respondents and on activated partial thromboplastin time (aPTT) among 46% of respondents, and on both for 2%. Different therapeutic ranges were used depending on local protocols and indications; the 0.3-0.7 IU/mL anti-Xa range was commonly used, except for patients on mechanical circulatory support with a lower range, mostly 0.3-0.5 IU/mL. Most respondents managed therapeutic UFH administration with weight-based dosing (88%), while fewer used a nomogram (57%) for dose adjustment. When a nomogram was used, it was primarily based on anti-Xa monitoring (86%). The situations when respondents administered antithrombin varied widely; 22% reported using it when antithrombin levels were below 60U/dL and 20% reported never using it. Conclusion: Our survey results revealed considerable heterogeneity in UFH management approaches, reflecting a knowledge gap and a paucity of evidence to guide decision-making. Key issues requiring well-designed up-to-date studies were identified, that include optimal approaches to heparin monitoring, assays and reagents to be used, therapeutic range based on indications, the use of weight-adjusted nomograms for initial dosing and titrating of UFH infusion, and indications for antithrombin supplementation. Our findings provide a strong rationale for the development of international guidance addressing these issues (under the aegis of professional societies including ISTH). Publication History Article published online: 13 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».