[Comparison of a nurse-directed weight-based heparin nomogram with standard empirical doctor-based heparin dosage].
OBJECTIVE
To assess efficiency of a nurse directed weight-based nomogram (NWN) for heparin dosage without training.


METHODS
Prospective, comparative, before/after intervention study.


METHODS
In a university medical intensive care unit, 19 patients receiving unfractionned intravenous heparin, following standard medical prescriptions (SHT), were compared to 19 patients submitted to NWN (80 U kg(-1) bolus, starting infusion at 18 U kg(-1) h(-1) and secondary dosage adaptations following a specific nomogram).


RESULTS
Dose of heparin bolus and starting dose infusion were significantly greater in NWN group than in the SHT group. The delay in achieving a predetermined therapeutic APTT level of at least 60 s was 6 (1-76) hours in the SHT group and 4 (3- 32) hours in the NWN group. The target APTT (60-85 s) was obtained after 13.5 (1-76) hours and 9.5 (3-32) hours in the two groups, respectively. Although reduction in delay seemed to favour anticoagulation dictated by the NWN protocol, the difference failed to reach statistical significance. Percentage of target APTT over total number of APTT values per patient was significantly higher in the NWN group (41 [0-87] vs. 31% [0-54]) in the SHT group. Strict observance of anticoagulation by using NWN tended to be better than that in SHT group.


CONCLUSIONS
NWN protocol was easy to use without previous training. NWN was associated with the best anticoagulation state although its superiority was less evident than expected.
Fraipont
V
V
Unité de soins intensifs médicaux, service de médecine interne, CHU Sart-Tilman, université de Liège, bâtiment B35, 4000 Liège, Belgique. vincent.fraipont@chrcitadelle.be
Lambermont
B
B
Moonen
M
M
D'Orio
V
V
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001835:Body Weight / Q000502:physiology; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010820:Physicians; D011446:Prospective Studies
D000925:Anticoagulants; D006493:Heparin