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1 November 1993 | Volume 119 Issue 9 | Pages 874-881
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 (APT) 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 (APT > 1.5 times the control) and the time to achieve therapeutic range (APT, 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.
Author and Article Information
From Good Samaritan Regional Medical Center, Phoenix, Arizona; the University of Rochester School of Medicine, Rochester, New York; St. Mary's Hospital, Rochester, New York.
ARTICLE
The Weight-based Heparin Dosing Nomogram Compared with a "Standard Care" Nomogram
A Randomized Controlled Trial
Requests for Reprints: Robert A. Raschke, MD, Department of Medicine, Good Samaritan Regional Medical Center, 1111 E. McDowell Road, Phoenix, AZ 85006.
Acknowledgments: The authors thank Drs. Alvin Mushlin, Barbara Weber, and Michael Wagner for their review of the manuscript and Dr. Philip C. Comp and Toppy Nelson for performing anti-factor Xa assays.
Grant Support: By The Palms Clinic, Phoenix, Arizona.
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