University of Pittsburgh School of Nursing
Alice Jane Haines has obtained her BSN from West Virginia Wesleyan College and her Master of Science in Nursing Education and Doctor of Nursing Practice from the University of Pittsburgh. She is currently an Assistant Professor in the Department of Acute and Tertiary Care at the University of Pittsburgh. She has worked for 33 years in Nursing and has 25 years of Nursing Education experience. She has also worked as a Staff Nurse for more than 5 years on a Lung Transplant Step-down Unit. Caring for Lung Transplant recipients and their caregivers is truly her passion.
Low molecular weight and unfractionated heparin have long been effective interventions to prevent and treat clots. Potential complications of this therapy includes bleeding, clotting or heparin Induced thrombocytopenia. Frequent monitoring of lab work is critical to maintain positive patient outcomes. When assessing therapeutic levels of unfractionated Heparin, two laboratory tests are available; the Activated Partial Thromboplastin Time (aPTT) and the Anti-Factor Xa Assay. The aPTT has been the gold standard for monitoring IV heparin for more than 50 years. It is cost-effective and familiar to most personnel. However, it has no standard result. Each hospital has their own therapeutic range based on equipment that is available. It was determined that a “normal therapeutic ” result was obtained when the patient’s aPTT was 1.5-2.5 times the control. This is now considered to be an unsafe assumption because in many cases, as the patient is actually sub-therapeutic when within this range. The Anti-Factor Xa Assay is recommended for monitoring unfractionated heparin by both the American College of Chest Physicians and the College of American Pathologists. Advantages of this test include less blood needed for the test, shorter time to therapeutic goal, fewer dosage adjustments and laboratory tests,. This may decrease hospital length of stay. Disadvantages include cost, initial errors form a learning curve and that after the blood has been obtained.the test must be completed within 1 hour The presenters will conclude by discussing how a major health system converted from the aPTT to the Anti-Xa Assay.