{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:15:08Z","timestamp":1755792908241,"version":"3.44.0"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Thromb Hemost"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n               Background\u2003The activated partial thromboplastin time (aPTT) and anti-factor-Xa levels (anti-Xa) are both used to monitor patients on unfractionated heparin. Our previous study demonstrated that patients with discordant high aPTT relative to anti-Xa had higher rates of mortality and bleeding events.<\/jats:p><jats:p>\n               Objective\u2003To determine if underlying patient characteristics drive both discordance and adverse outcomes or if discordance is an independent risk factor to adverse outcomes.<\/jats:p><jats:p>\n               Methods\u2003We analyzed all patients hospitalized at the Stanford Hospital between January 2011 and December 2019 who had simultaneous aPTT and anti-Xa levels performed. From the electronic medical record, we extracted and analyzed 51 patient features including baseline coagulation laboratory results, demographics, values of other common laboratories (basic metabolic panel, complete blood count, etc.), diagnostic procedures, medications, and death.<\/jats:p><jats:p>\n               Results\u2003A total of 17,728 patients had 78,701 paired aPTT and anti-Xa levels. Patients with discordant aPTT and anti-Xa where aPTT (seconds) was elevated beyond the expected therapeutic range had a higher 30-day mortality (odds ratio [OR]: 2.16, 95% confidence interval [CI]: 1.78\u20132.63, p\u2009&lt;\u20090.001). Sectioning the patients based on the degree of discordance and whether aPTT or anti-Xa were signaling excess anticoagulation, we found those with an elevated aPTT discordant to their anti-Xa level had the highest odds of death (OR: 2.46, 95% CI: 1.99\u20133.10) compared with the concordant group. This finding was still present after controlling for patient comorbidity and other laboratory results at hospital admission.<\/jats:p><jats:p>\n               Conclusion\u2003After controlling for patient features strongly associated with increased mortality in heparinized patients, we identified that the discordant pattern of high aPTT to anti-Xa served as an independent predictor of 30-day all-cause mortality, with a higher degree of discordance associated with increased odds of 30-day mortality.<\/jats:p>","DOI":"10.1055\/s-0044-1789020","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T19:33:25Z","timestamp":1724787205000},"page":"667-675","source":"Crossref","is-referenced-by-count":1,"title":["Discordant High Activated Partial Thromboplastin Time Relative to Anti-Xa Values in Hospitalized Patients is an Independent Risk Factor for Increased 30-day Mortality"],"prefix":"10.1055","volume":"51","author":[{"given":"Jing","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Special Coagulation, Clinical Laboratories, Stanford Health Care, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santosh","family":"Gummidipundi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joe","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Husham","family":"Sharifi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Boothroyd","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anandi","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Stanford University School of Medicine, Stanford, California, United States"},{"name":"Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James L.","family":"Zehnder","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Stanford, California, United States"},{"name":"Department of Pathology, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,8,27]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"e141","DOI":"10.1515\/cclm-2014-0906","article-title":"Interference of C-reactive protein with clotting times","volume":"53","author":"K M Devreese","year":"2015","journal-title":"Clin Chem Lab Med"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12865-017-0213-0","article-title":"IgMk paraprotein from gammopathy patient can bind to cardiolipin and interfere with coagulation assay: a case report","volume":"18","author":"X Y Wu","year":"2017","journal-title":"BMC Immunol"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1182\/blood.V43.4.493.493","article-title":"A monoclonal IgM with antibodylike specificity for phospholipids in a patient with lymphoma","volume":"43","author":"M R Cooper","year":"1974","journal-title":"Blood"},{"issue":"09","key":"ref4","first-page":"782","article-title":"College of American Pathologists Conference XXXI on laboratory monitoring of anticoagulant therapy: laboratory monitoring of unfractionated heparin therapy","volume":"122","author":"J D Olson","year":"1998","journal-title":"Arch Pathol Lab Med"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1378\/chest.08-0782","article-title":"Reflecting on eight editions of the American College of Chest Physicians antithrombotic guidelines","volume":"133","author":"J Hirsh","year":"2008","journal-title":"Chest"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1002\/j.1875-9114.2011.01049.x","article-title":"Antifactor Xa levels versus activated partial thromboplastin time for monitoring unfractionated heparin","volume":"32","author":"J W 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Price","year":"2013","journal-title":"Ann Pharmacother"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1309\/AJCPS6OW6DYNOGNH","article-title":"Activated partial thromboplastin time and anti-Xa measurements in heparin monitoring: biochemical basis for discordance","volume":"139","author":"C M Takemoto","year":"2013","journal-title":"Am J Clin Pathol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.thromres.2019.01.002","article-title":"Agreement between activated partial thromboplastin time and anti-Xa activity in critically ill patients receiving therapeutic unfractionated heparin","volume":"175","author":"D Ratano","year":"2019","journal-title":"Thromb Res"},{"issue":"11","key":"ref12","first-page":"e0999","article-title":"Anti-factor-Xa and activated partial thromboplastin time concordance and outcomes in adults undergoing extracorporeal membrane oxygenation: a secondary analysis of the pilot low-dose heparin 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