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Ann Intern Med. 1993 Nov 1;119(9):874-81.

The weight-based heparin dosing nomogram compared with a "standard care" nomogram. A randomized controlled trial.

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1
Good Samaritan Regional Medical Center, Phoenix, Arizona.

Abstract

OBJECTIVE:

To determine whether an intravenous heparin dosing nomogram based on body weight achieves therapeutic anticoagulation more rapidly than a "standard care" nomogram.

DESIGN:

Randomized controlled trial.

SETTING:

Two community teaching hospitals in Phoenix, Arizona, and Rochester, New York.

PARTICIPANTS:

One hundred fifteen patients requiring intravenous heparin treatment for venous or arterial thromboembolism or for unstable angina.

INTERVENTION:

Patients were randomized to the weight-based nomogram (starting dose, 80 units/kg body weight bolus, 18 units/kg per hour infusion) or the standard care nomogram (starting dose, 5000-unit bolus, 1000 units per hour infusion). Activated partial thromboplastin time (APTT) values were monitored every 6 hours, and heparin dose adjustments were determined by the nomograms.

MEASUREMENTS:

Activated partial thromboplastin times were measured using a widely generalizable laboratory method. The primary outcomes were the time to exceed the therapeutic threshold (APTT > 1.5 times the control) and the time to achieve therapeutic range (APTT, 1.5 to 2.3 times the control). Bleeding complications and recurrent thromboembolism were also compared.

RESULTS:

Kaplan-Meier curves for the primary outcomes favored the weight-based nomogram (P < 0.001 for both). In the weight-based heparin group, 60 of 62 patients (97%) exceeded the therapeutic threshold within 24 hours, compared with 37 of 48 (77%) in the standard care group (P < 0.002). Only one major bleeding complication occurred (in a standard care patient). Recurrent thromboembolism was more frequent in the standard care group; relative risk, 5.0 (95% CI, 1.1 to 21.9).

CONCLUSIONS:

The weight-based heparin nomogram is widely generalizable and has proved to be effective, safe, and superior to one based on standard practice.

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PMID:
8214998
[Indexed for MEDLINE]
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