Use of an algorithm for administering subcutaneous heparin in the treatment of deep venous thrombosis.
BACKGROUND
Despite the widespread use of subcutaneous heparin in the initial treatment of deep venous thrombosis, there are no guidelines for achieving adequate anticoagulation with this drug.


OBJECTIVE
To implement a weight-based algorithm for the administration of subcutaneous unfractionated heparin after an intravenous loading dose.


METHODS
Prospective cohort study.


METHODS
University hospital.


METHODS
70 outpatients with proximal venous thrombosis.


METHODS
An intravenous bolus of heparin followed by a subcutaneous injection of heparin in doses adjusted for body weight. Subsequent adjustments of the subcutaneous heparin dose were scheduled twice daily according to the algorithm; the activated partial thromboplastin time (aPTT) was measured in the mid-interval (target range, 50 to 90 seconds).


RESULTS
The therapeutic threshold aPTT (> or = 50 seconds) was achieved in 61 patients (87%) within 24 hours and in 69 patients (99%) within 48 hours. In 7 patients (10%), a supratherapeutic aPTT lasted more than 12 hours. No major bleeding episodes or cases of heparin-induced thrombocytopenia were seen. Three patients (4.3% [95% CI, 0.9% to 12.0%]) had recurrent thromboembolism during 3 months of follow-up.


CONCLUSIONS
The administration of subcutaneous heparin according to a weight-based algorithm allows the rapid achievement of effective and safe anticoagulation in patients with deep venous thrombosis.
Prandoni
P
P
University of Padua Medical School, Italy.
Bagatella
P
P
Bernardi
E
E
Girolami
B
B
Rossi
L
L
Scarano
L
L
Marchiori
A
A
Piccioli
A
A
Girolami
A
A
D000368:Aged; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D001835:Body Weight; D004334:Drug Administration Schedule; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011446:Prospective Studies; D013924:Thrombophlebitis / Q000188:drug therapy*
D000925:Anticoagulants; D006493:Heparin