The Relationship between the Initial Anti-factor Xa Measurement and the Duration of Direct Oral Anticoagulant Influence in Patients Transitioning to Heparin.

BACKGROUND: Anticoagulation monitoring during transition from direct oral anticoagulants (DOAC) to heparin infusions is a significant challenge. Factor Xa inhibitors influence the heparin calibrated antifactor Xa assay. The University of Virginia (UVA) Medical Center utilized a corrected antifactor Xa assay (c-AXA) during this transition period, which removes DOAC-mediated antifactor Xa activity (d-AXA) and reflects heparin-specific activity. Currently, the duration of this influence is not well described. STUDY OBJECTIVE: This study had two aims: to determine if the initial d-AXA is predictive of the duration of DOAC influence and to further characterize this influence among different patient populations. METHODS: This retrospective study included adult patients admitted to UVA Medical Center between September 2016 and March 2017, with c-AXA measurements, who received apixaban or rivaroxaban within 48 hours before heparin initiation. A Pearson correlation test, Kaplan-Meier Survival Analysis, and multivariate linear regression were used to assess the relationship between initial d-AXA and duration of influence. RESULTS: Sixty-eight patients met inclusion criteria and were maintained on either apixaban (85%) or rivaroxaban (15%) before heparin initiation. The initial d-AXA ranged from 0.11 to 3.27 IU/ml. The mean duration of influence was 69.3 ± 46.2 hours, with a median duration of 62.7 hours. No strong correlation was identified between initial d-AXA and duration of influence (R2 = 0.124). Presence of interacting medications significantly increased duration of influence (p=0.012). No significant difference in duration of influence existed between patients with normal renal function and those with dynamic renal function (p=0.84), or with body mass index (BMI) greater than 40 kg/m2 (p=0.16). CONCLUSIONS: The initial d-AXA was not predictive of duration of influence in patients transitioning from DOACs to heparin infusion; however, the median duration of influence suggests influence may be present for longer than currently stated in the literature, especially in those taking interacting medications.

Evaluation of pharmacist continuing professional development portfolios.

OBJECTIVE: The purpose of this study was to conduct a random continuing professional development (CPD) portfolio audit to assess the portfolios of pharmacists who completed CPD training in the state of North Carolina and reported adopting it in place of the annual 15-hour continuing education (CE) requirement when applying for re-licensure. METHODS: The NC Board of Pharmacy (NCBOP) staff randomly selected 30 pharmacists to provide CPD portfolio documentation to the Board electronically or in paper format. This documentation included their completed learning plan, a learning activity worksheet for each completed activity, and the Accreditation Council on Pharmacy Education (ACPE) universal activity number for the CPD training program attended. The Task Force used a multicomponent audit tool to assess each portfolio. RESULTS: Eighty percent of portfolios had at least 15 hours of learning reported. Portfolio assessments indicated an average of 5 learning objectives per individual. Based on the scale of 1 to 5, the Measurable and Specific sections of the objectives scored the lowest with an average score of 3 on both sections. An overall assessment of "adequate" or "comprehensive" was noted for 60% of the portfolios. CONCLUSION: Pharmacists completing CPD training are capable of following the CPD process with some potential challenges in documentation. Information submitted to the board of pharmacy is considered sufficient for license renewal purposes.