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Clinical safety and cost of heparin titration using bedside activated clotting time
T Thomason1, B Riegel, D Jessen
1Intensive Care/Progressive Care Units, Sharp Cabrillo Hospital, San Diego, CA 92110.
Objective:
To evaluate the clinical safety of heparin titration and the procedural cost of anticoagulation measurement using bedside low-range activated clotting time.
Design:
Quasi-experimental study using data gathered through retrospective record review.
Setting:
Coronary care, medical intensive care and telemetry units of a community hospital.
Subjects:
Sample of 102 patients undergoing elective percutaneous transluminal coronary angioplasty.
Intervention:
Intravenous heparin therapy was titrated using low-range activated clotting time in 51 percutaneous transluminal coronary angioplasty patients. Data from this group were compared to a matched sample of 51 angioplasty patients whose intravenous heparin therapy was titrated using activated partial thromboplastin time.
Results:
No differences in procedural, early or late complications were found between the groups. The cost of managing heparin therapy with low-range activated clotting time was less than with activated partial thromboplastin time.
Conclusion:
These results suggest that titrating heparin therapy based on bedside low-range activated clotting time for the angioplasty patients in this sample was as safe as with activated partial thromboplastin time. Use of bedside low-range activated clotting time saved money for the hospital.