Bedside Anticoagulant Testing

Anticoagulants are central in the management of both atherothrombotic arterial and venous disorders. Unfractionated heparin (UFH) is currently the most widely used intravenous anticoagulant, but its dominance is progressively being supplanted by low molecularweight heparins (LMWH) and direct thrombin inhibitors. Nevertheless, at this juncture, the prevalence of UFH use necessitates knowledge of monitoring its anticoagulant effect, especially in the setting where high doses are required for therapeutic efficacy. Unfortunately, UFH has a relatively narrow therapeutic window, thus setting the premise for the monitoring of anticoagulant activity to optimize efficacy while maintaining safety. In this chapter, we will specifically review the role of bedside anticoagulant monitoring devices of antithrombin activity. There is considerably less need for routine anticoagulant monitoring of LMWH and direct thrombin inhibitors, given their more favorable pharmacokinetics; these will be briefly discussed as well.