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[Inappropriate prescription of heparin at curative doses in the hospital. Can the information to prescribing
C E Geffroy1, E Couffin, J Doucet
1Service de Médecine interne Gériatrique, CHU de Rouen, F 76031 Rouen.
Presse Medicale (Paris, France : 1983)
|March 20, 2002
Summary
Hospital heparin prescriptions often deviate from official guidelines, especially for elderly patients and those with renal issues. Physician education improved some practices but had limited impact on overall heparin dosing and complication rates.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Internal Medicine
Background:
- Heparin is crucial for treating thromboembolic events.
- Adherence to official recommendations for heparin dosing and monitoring is vital for patient safety.
- Variations in clinical practice may lead to suboptimal heparin use.
Purpose of the Study:
- To assess compliance of curative heparin prescriptions with official guidelines.
- To inform physicians about prescription deviations and evaluate the impact of this feedback.
- To improve the safety and efficacy of heparin therapy in hospitalized patients.
Main Methods:
- A prospective study evaluated heparin prescriptions in three phases: initial assessment, information dissemination, and final assessment.
- Data collected included indications, drug choice, dosage, and patient monitoring.
- Prescriptions of non-fractionated heparin, enoxaparin, and tinzaparin were analyzed.
Main Results:
- Initially, 54.3% of low molecular weight heparin (LMWH) prescriptions did not comply with recommendations.
- Inappropriate dosing and inadequate platelet monitoring were common.
- Post-intervention, some improvements were noted, but significant changes in mean doses and complication rates were not observed.
Conclusions:
- Heparin prescription practices in hospitals often differ from clinical study data, particularly concerning patient age, renal function, and comorbidities.
- Physician education had a limited but real influence on prescription habits.
- Official recommendations need refinement, especially for patients at increased risk of bleeding.