Evaluation of an intravenous heparin nomogram in a coronary care unit.
OBJECTIVE
To develop, implement and evaluate an effective and efficient heparin nomogram.


METHODS
Retrospective and prospective data collection.


METHODS
Coronary care unit (CCU) of a university-affiliated hospital.


METHODS
Patients with acute coronary ischemic syndromes requiring intravenous (i.v.) heparin who were not receiving thrombolytic and/or warfarin therapy.


METHODS
A retrospective chart review of 52 CCU patients receiving iv heparin provided the historical control group. The effectiveness of a heparin nomogram (5000 U bolus followed by an initial weight-based infusion of 15 U/kg/h with subsequent rate adjustments according to activated partial thromboplastin time [aPTT] results) was then prospectively assessed in a further 56 consecutive patients.


RESULTS
The historical control and nomogram groups did not significantly differ with respect to age, weight, duration of therapy or total number of aPTTs drawn. Approximately 79% and 84% of patients in the control and nomogram groups, respectively, achieved an aPTT within the therapeutic range (60 to 90 s, P > 0.05), whereas 89% and 100% of control and nomogram patients, respectively, surpassed the therapeutic threshold (longer than 60 s) at some point during treatment (P = 0.009). Compared with empiric dose adjustment, the nomogram more effectively avoided periods of inadequate anticoagulation. Similarly, the time to achieve the therapeutic threshold was significantly longer in the control than in the nomogram group (8.2 +/- 5.9 versus 6.7 +/- 3.7 h, P = 0.026). No adverse bleeding events were noted in either group.


CONCLUSIONS
Compared with conventional approaches, the heparin nomogram successfully achieved and maintained adequate anticoagulation in a greater proportion of patients with acute cardiovascular diseases without the need for additional aPTT measurements.
Paradiso-Hardy
F L
FL
Department of Pharmacy and Medicine, Sunnybrook Health Science Centre, University of Toronto, Ontario.
Cheung
B
B
Geerts
W H
WH
D000208:Acute Disease; D000789:Angina, Unstable / Q000628:therapy; D001281:Atrial Fibrillation / Q000628:therapy; D002170:Canada; D003325:Coronary Care Units; D003625:Data Collection; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D017202:Myocardial Ischemia / Q000628:therapy*; D009864:Ontario; D011446:Prospective Studies; D012189:Retrospective Studies
D006493:Heparin