Computer-assisted dosing of heparin: Management with a pharmacy-based anticoagulation service

Beverly Kershaw, Richard H White, Dennis Mungall, Jeff Van Hauten, Stefan Brettfeld

Research output: Contribution to journalArticle

Abstract

Background: Expert consultation by means of established practice guidelines has been shown to lead to improved accuracy of inpatient anticoagulation therapy, with a reduction in the frequency of hemorrhagic complications. We evaluated a different strategy to improve the accuracy of in-hospital anticoagulation: pharmacy-based, computer-assisted dosing of intravenous heparin therapy. Methods: Patients treated with computer-assisted dosing of heparin (N=131) were compared with a randomly selected historical cohort (N=57) in whom heparin therapy was managed by the primary physician. All patients treated by the pharmacy team received a bolus of heparin, 70 U/kg of ideal body weight, except for patients with pulmonary embolism, who received 100 U/kg of ideal body weight. A computer-generated infusion dose was selected (generally 13 to 16 U/kg per hour). The target was an activated partial thromboplastin time (APTT) ratio of 1.8 times the patient's baseline APTT, with a therapeutic range of 1.5 to 2.5 times baseline. Computer- assisted dosage recommendations were generated after each APTT measurement. Results: In the historical control group, 62% of the patients achieved a therapeutic APTT during the first 24 hours; 17% failed to reach a therapeutic level by 48 hours. The median time to reach a therapeutic APTT was 15 hours. Of all 696 APTTs in this group, 42% were below, 43% in, and 15% above the therapeutic range. In the computer-assisted group, 90% achieved a therapeutic APTT within 24 hours (P<.001); 97% had a therapeutic APTT by 48 hours (P<.01). The median time to achieve a therapeutic APTT was 7 hours (P<.001). Of all 880 APTTs in this group, 17% were below, 75% in, and 8% above the therapeutic range (P<.001). Conclusions: Pharmacy-based, computer-assisted dosing of heparin is feasible and results in faster and more accurate anticoagulant dosing.

Original languageEnglish (US)
Pages (from-to)1005-1011
Number of pages7
JournalArchives of Internal Medicine
Volume154
Issue number9
DOIs
StatePublished - May 9 1994

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Heparin
Partial Thromboplastin Time
Therapeutics
Ideal Body Weight
Pulmonary Embolism
Practice Guidelines
Anticoagulants
Inpatients
Referral and Consultation
Physicians
Control Groups

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Computer-assisted dosing of heparin : Management with a pharmacy-based anticoagulation service. / Kershaw, Beverly; White, Richard H; Mungall, Dennis; Van Hauten, Jeff; Brettfeld, Stefan.

In: Archives of Internal Medicine, Vol. 154, No. 9, 09.05.1994, p. 1005-1011.

Research output: Contribution to journalArticle

Kershaw, Beverly ; White, Richard H ; Mungall, Dennis ; Van Hauten, Jeff ; Brettfeld, Stefan. / Computer-assisted dosing of heparin : Management with a pharmacy-based anticoagulation service. In: Archives of Internal Medicine. 1994 ; Vol. 154, No. 9. pp. 1005-1011.
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abstract = "Background: Expert consultation by means of established practice guidelines has been shown to lead to improved accuracy of inpatient anticoagulation therapy, with a reduction in the frequency of hemorrhagic complications. We evaluated a different strategy to improve the accuracy of in-hospital anticoagulation: pharmacy-based, computer-assisted dosing of intravenous heparin therapy. Methods: Patients treated with computer-assisted dosing of heparin (N=131) were compared with a randomly selected historical cohort (N=57) in whom heparin therapy was managed by the primary physician. All patients treated by the pharmacy team received a bolus of heparin, 70 U/kg of ideal body weight, except for patients with pulmonary embolism, who received 100 U/kg of ideal body weight. A computer-generated infusion dose was selected (generally 13 to 16 U/kg per hour). The target was an activated partial thromboplastin time (APTT) ratio of 1.8 times the patient's baseline APTT, with a therapeutic range of 1.5 to 2.5 times baseline. Computer- assisted dosage recommendations were generated after each APTT measurement. Results: In the historical control group, 62{\%} of the patients achieved a therapeutic APTT during the first 24 hours; 17{\%} failed to reach a therapeutic level by 48 hours. The median time to reach a therapeutic APTT was 15 hours. Of all 696 APTTs in this group, 42{\%} were below, 43{\%} in, and 15{\%} above the therapeutic range. In the computer-assisted group, 90{\%} achieved a therapeutic APTT within 24 hours (P<.001); 97{\%} had a therapeutic APTT by 48 hours (P<.01). The median time to achieve a therapeutic APTT was 7 hours (P<.001). Of all 880 APTTs in this group, 17{\%} were below, 75{\%} in, and 8{\%} above the therapeutic range (P<.001). Conclusions: Pharmacy-based, computer-assisted dosing of heparin is feasible and results in faster and more accurate anticoagulant dosing.",
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