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The effectiveness of implementing the weight-based heparin nomogram as a practice guideline
R A Raschke1, B Gollihare, J C Peirce
1Good Samaritan Regional Medical Center, Phoenix, Ariz, USA.
Archives of Internal Medicine
|August 12, 1996
Summary
The weight-based heparin nomogram improved heparin dosing and reduced time to therapeutic levels in a community hospital. However, effectiveness may decrease when guidelines move from research to practice, necessitating ongoing monitoring.
Area of Science:
- Clinical Pharmacy
- Pharmacology
- Evidence-Based Medicine
Background:
- Venous thromboembolism (VTE) management requires precise anticoagulation.
- Weight-based heparin nomograms are used to guide VTE treatment.
- Implementation of practice guidelines in community hospitals can impact patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a weight-based heparin nomogram as a practice guideline in a community hospital setting.
- To assess the impact of nomogram implementation on anticoagulation control and bleeding complications.
Main Methods:
- A nonexperimental, retrospective time series study was conducted.
- 591 patients with VTE were analyzed over a 5-year period at a community teaching hospital.
- The weight-based heparin nomogram was implemented via a preprinted order sheet.
Main Results:
- Nomogram implementation reached 94% voluntary use.
- Increased initial heparin dose and decreased time to therapeutic activated partial thromboplastin time (aPTT) were observed.
- No increase in bleeding rates was noted, but a decrease in achieving therapeutic aPTT within 24 hours was seen compared to efficacy trials.
Conclusions:
- The weight-based heparin nomogram was well-accepted and improved intermediate outcomes like heparin dosing and aPTT control.
- A potential mitigation of benefit occurs when guidelines transition from efficacy research to clinical practice.
- Continuous monitoring of guideline effectiveness in real-world settings is crucial.
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