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[Adherence to and Issues on our Institutional Guidelines on Heparin Administration after Withdrawal of Warfarin
Insights
Local heparin bridging therapy guidelines showed partial effectiveness in improving adherence. Physicians should remain vigilant for bleeding complications during this therapy.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Local guidelines for heparin bridging therapy were established.
- The impact of these guidelines on adherence and comparison with universal guidelines remain unclear.
Purpose of the Study:
- To assess adherence to local heparin bridging therapy guidelines.
- To compare adherence to guideline recommendations versus platelet monitoring.
- To evaluate bleeding and thromboembolic events during heparin bridging therapy.
Main Methods:
- Retrospective chart review of compliance with three guideline recommendations: initial unfractionated heparin dose, timing of administration, and activated partial thromboplastin time (APTT) measurements.
- Comparison of guideline adherence with platelet monitoring.
- Investigation of bleeding and thromboembolic events.
Main Results:
- Adherence rates were 78.9% for initial unfractionated heparin dose, 19.7% for timing of administration, and 67.6% for APTT measurements.
- Platelet monitoring adherence was 46.5%.
- Adherence to the timing of unfractionated heparin administration was the lowest and significantly less than platelet monitoring. Three bleeding events occurred; no thromboembolic events were reported.
Conclusions:
- Local heparin bridging therapy guidelines demonstrated partial effectiveness in improving adherence.
- Physicians need to be alerted to potential bleeding complications during heparin bridging therapy in the hospital setting.
Background:
We established local guidelines of heparin bridging therapy. However, it is unknown how adherence to our guidelines was achieved and whether our guidelines improved adherence compared with other universal guidelines.
Methods:
A retrospective chart review was con- ducted on compliance with 3 recommendations in the guidelines; these are initial unfractioned heparin dose, timing of unfractioned heparin administration, and two times measurements of activated partial thromboplas- tin time (APTT). We compared 3 recommendations in the guidelines with platelet monitoring which is not described in the guidelines. We also investigated bleed- ing and thromboembolic events during heparin bridg- ing therapy according to the guidelines.
Results:
Initial unfractioned heparin dose, timing of unfractioned heparin administration, measurements of APTT, and platelet monitoring were concordant with the guidelines in 78.9%, 19.7%, 67.6%, and 46.5%, respectively. Bleeding events occurred in 3 cases, but no thromboembolic events occurred. Adherence to rec- ommendations for timing of unfractioned heparin administration was the lowest and significantly lower than platelet monitoring.
Conclusions:
Our local guidelines were partially effective to improve adherence We have to alert phy- sicians to care bleeding complications during heparin bridging therapy in our hospital.
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