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Appropriate use of heparin. Empiric vs nomogram-based dosing
P S Gunnarsson1, W T Sawyer, D Montague
1School of Pharmacy, University of North Carolina at Chapel Hill.
Archives of Internal Medicine
|March 13, 1995
Summary
A weight-based nomogram for heparin dosing significantly improved the speed and success rate of achieving therapeutic activated partial thromboplastin time (APTT) in cardiovascular patients compared to standard empiric dosing.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Pharmacy
Background:
- Cardiovascular disease management often involves heparin therapy.
- Achieving a therapeutic activated partial thromboplastin time (APTT) is crucial for effective anticoagulation.
- Empiric heparin dosing can lead to variable patient responses.
Purpose of the Study:
- To compare the efficacy of empiric heparin therapy versus nomogram-guided heparin therapy.
- To evaluate the time to achieve therapeutic APTT and the infusion rates in two patient groups.
Main Methods:
- A comparative study involving two phases of patient data collection.
- Phase 1: 88 patients receiving empiric heparin therapy.
- Phase 2: 45 patients receiving nomogram-guided heparin therapy based on weight-adjusted infusion rates.
Main Results:
- Nomogram-guided therapy (Phase 2) resulted in a higher percentage of patients achieving therapeutic APTT (91.1%) compared to empiric therapy (75.0%).
- The average time to therapeutic APTT was significantly shorter in Phase 2 (13.1 hours) than in Phase 1 (20.7 hours).
- A greater proportion of patients in Phase 2 reached therapeutic APTT within 12 and 24 hours.
Conclusions:
- Weight-based nomogram use for heparin dosing enhances the achievement of therapeutic APTT.
- Nomogram-guided therapy leads to faster attainment of target APTT levels in cardiology patients.
- This approach improves the efficiency of heparin therapy initiation.