Use of an algorithm for administering subcutaneous heparin in the treatment of deep venous thrombosis.

Abstract

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.

DESIGN:

Prospective cohort study.

SETTING:

University hospital.

PARTICIPANTS:

70 outpatients with proximal venous thrombosis.

INTERVENTION:

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.

CONCLUSION:

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.

• Authors: P Prandoni, P Bagatella, E Bernardi, B Girolami, L Rossi, L Scarano, A Marchiori, A Piccioli, A Girolami
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 129 Issue 4 Pg. 299-302 (Aug 15 1998) ISSN: 0003-4819 [Print] United States
• PMID: 9729183 (Publication Type: Journal Article)

Chemical References

• Anticoagulants
• Heparin

Topics

• Aged
• Algorithms
• Anticoagulants (administration & dosage, therapeutic use)
• Body Weight
• Drug Administration Schedule
• Female
• Heparin (administration & dosage, therapeutic use)
• Humans
• Injections, Subcutaneous
• Male
• Middle Aged
• Partial Thromboplastin Time
• Prospective Studies
• Thrombophlebitis (drug therapy)