APTT监测普通肝素抗凝治疗.pdf

© 2006 Schattauer GmbH, Stuttgart Theme Issue Article Monitoring unfractionated heparin with the aPTT: Time for a fresh look 1 2 Jo hnW. Eikelboom , Jack Hirsh 1 2 Thrombosis Service, Hamilton General Hospital, Hamilton Health Sciences Corporation and McMaster University, Henderson Research Centre, Hamilton Health Sciences Corporation and McMaster University; Hamilton, Ontario, Canada Summary Laboratory monitoring is widely recommended to measure the limitations,the reliance on the aPTT is likely to continue because anticoagulant effect of unfractionated heparin and to adjust the of its ready availability and familiarity of clinicians with the test. dose to maintain levels in the target therapeutic range.The most The focus of clinicians who manage unfractionated heparin ther- widely used laboratory assay for monitoring unfractionated he- apy should be to ensure that an adequate starting dose of un- parin therapy is the activated partial thromboplastin time fractionated heparin is used and that the aPTT method is stan- (aPTT). A fixed therapeutic range for the aPTT of 1.5 to 2.5 dardized. Future research efforts should be directed towards times the control value has become widely accepted,but the evi- developing methods to improve standardization of the aPTT dence supporting this range is weak and the clinical validity of assay for monitoring unfractionated heparin. Direct measures of using the aPTT for predicting thrombotic or bleeding events is the concentration of unfractionated heparin in the blood are at- questionable.The aPTT test is also affected by numerous pre- tracti