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Recurrence of Venous Thromboembolism after Treatment with Unfractionated Heparin
- Jan Dirk Banga, MD;
- H.W. de Valk, MD; and
- H.K. Nieuwenhuis, MD
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IN RESPONSE:
Dr. Sutton raises an important issue about the optimal dosage of heparin. The predefined therapeutic range of heparin used in our study corresponded to a heparin level of 0.25 to 0.40 U/mL, which is narrower than the generally recommended range of 0.20 to 0.40 U/mL [1]. The dosing practice was standardized and consisted of measurement of the activated partial thromboplastin time 4 hours after any dose adjustment and immediate adjustment of the heparin dosage if the activated partial thromboplastin time was outside the therapeutic range. With this protocol, 15 of the 17 patients in whom thromboembolism recurred while they were receiving heparin exceeded the therapeutic threshold of 0.20 U/mL within 24 hours. Thus, these patients had silent recurrences despite adequate heparinization. Two patients with recurring thromboembolism did not reach the therapeutic range within 24 hours, and this factor may have played a role in the recurrence. We disagree with Dr. Sutton that this regimen is substandard.
Study treatment was given for at least 5 days and was continued until an international normalized ratio of 3.0 was achieved [2]. Treatment lasted 6 days or longer in 86% of patients and 7 days or longer in 57%. Heparin and oral anticoagulation were concurrently administered to all patients for at least 3 days.
Jan Dirk Banga, MD
H.W. de Valk, MD
H.K. Nieuwenhuis, MD
Academic Hospital Utrecht
3508 GA Utrecht, the Netherlands
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
