Title

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

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine

Date

1-1999

Document Type

Article

Subjects

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

Disciplines

Cardiology | Cardiovascular Diseases | Preventive Medicine

Abstract

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.

Rights and Permissions

Citation: Am Heart J. 1999 Jan;137(1):59-71.

Related Resources

Link to article in PubMed

PubMed ID

9878937