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

Robert A. Raschke, Brendan M. Reilly, James R. Guidry, Joseph R. Fontana, Sandhya Srinivas

Research output: Contribution to journalArticlepeer-review

652 Scopus citations

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% Cl, 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.

Original languageEnglish (US)
Pages (from-to)874-881
Number of pages8
JournalAnnals of internal medicine
Volume119
Issue number9
DOIs
StatePublished - Nov 1 1993
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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