Accuracy, reproducibility and costs of different laboratory assays for the monitoring of unfractionated heparin in clinical practice: a prospective evaluation study and survey among Swiss institutions

BMJ Open. 2018 Jun 9;8(6):e022943. doi: 10.1136/bmjopen-2018-022943.


Objectives: To investigate the accuracy, reproducibility and costs of different laboratory assays for the monitoring of unfractionated heparin (UFH) in clinical practice and to study test utilisation in Switzerland.

Design: Prospective evaluation study and survey among Swiss hospitals and laboratories.

Setting: Secondary care hospital in rural Switzerland (evaluation study); all Swiss hospitals and laboratories (survey).

Participants: All consecutive patients, monitored for treatment with UFH during two time periods, were included (May to July 2014 and January to February 2015; n=254).

Outcome measures: Results of activated partial thromboplastin time (aPTT), thrombin time (TT), prothrombinase-induced clotting time (PiCT) and anti-Xa activity with respect to UFH concentration RESULTS: Spearman's correlation coefficient (rs) with regard to anti-Xa activity was 0.68 (95% CI 0.60 to 0.75) for aPTT, 0.79 (0.69 to 0.86) for TT and 0.94 (0.93 to 0.95) for PiCT. The correlation (rs) between anti-Xa activity and heparin concentration as determined by spiking plasma samples was 1.0 (1.0 to 1.0). The coefficient of variation was at most 5% for PiCT and anti-Xa activity (within-run as well as day-to-day variability). The total costs per test in Swiss Francs (SFr) were SFr23.40 for aPTT, SFr33.30 for TT, SFr15.70 for PiCT and SFr24.15 for anti-Xa activity. The various tests were employed in Swiss institutions with the following frequencies: aPTT 53.2%, TT 21.6%, anti-Xa activity 7.2%, PiCT 1.4%; 16.6% of hospitals performed more than one test.

Conclusions: The accuracy and reproducibility of PiCT and anti-Xa activity for monitoring of UFH was superior, and analytical costs were equivalent to or lower than aPTT and TT.

Keywords: drug monitoring; health care costs; heparin/therapy; partial thromboplastin time; thrombin time.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Coagulation Tests / economics*
  • Blood Coagulation Tests / standards*
  • Costs and Cost Analysis
  • Drug Monitoring / methods*
  • Heparin / blood*
  • Humans
  • Linear Models
  • Prospective Studies
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Switzerland
  • Time Factors


  • Heparin