A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease. Antithrombotic Therapy Consortium Investigators
Department of Medicine, Division of Preventive and Behavioral Medicine
Adult; Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation; Confounding Factors (Epidemiology); Decision Trees; Female; Heparin; Hospitalization; Humans; Male; Middle Aged; Partial Thromboplastin Time; Point-of-Care Systems; Thromboembolism; Time Factors; United States
Cardiology | Cardiovascular Diseases | Preventive Medicine
BACKGROUND: Therapy with intravenous unfractionated heparin improves clinical outcome in patients with active thromboembolic disease, but achieving and maintaining a therapeutic level of anticoagulation remains a major challenge for clinicians.
METHODS: A total of 113 patients requiring heparin for at least 48 hours were randomly assigned at 7 medical centers to either weight-adjusted or non-weight-adjusted dose titration. They were separately assigned to either laboratory-based or point-of-care (bedside) coagulation monitoring.
RESULTS: Weight-adjusted heparin dosing yielded a higher mean activated partial thromboplastin time (aPTT) value 6 hours after treatment initiation than non-weight-adjusted dosing (99.9 vs 78.8 seconds; P =.002) and reduced the time required to exceed a minimum threshold (aPTT >45 seconds) of anticoagulation (10.5 vs 8.6 hours; P =.002). Point-of-care coagulation monitoring significantly reduced the time from blood sample acquisition to a heparin infusion adjustment (0.4 vs 1.6 hours; PCONCLUSIONS: Weight-adjusted heparin dosing according to a standardized titration nomogram combined with point-of-care coagulation monitoring using the BMC Coaguchek Plus System represents an effective and widely generalizable strategy for managing patients with thromboembolic disease that fosters the rapid achievement of a desired range of anticoagulation. Additional work is needed, however, to improve on existing patient-specific strategies that can more effectively sustain a therapeutic state of anticoagulation.
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Citation: Am Heart J. 1999 Jan;137(1):59-71.
Becker, Richard C.; Ball, Steven P.; Eisenberg, Paul; Borzak, Steven; Held, A. Christian; Spencer, Frederick A.; Voyce, Stephen J.; Jesse, Robert; Hendel, Robert C.; Ma, Yunsheng; Hurley, Thomas G.; and Hebert, James R., "A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease. Antithrombotic Therapy Consortium Investigators" (1999). Preventive and Behavioral Medicine Publications and Presentations. 31.