A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease

Richard C. Becker, Steven P. Ball, Paul Eisenberg, Steven Borzak, A. Christian Held, Frederick Spencer, Stephen J. Voyce, Robert Jesse, Robert Hendel, Yunsheng Ma, Thomas Hurley, James Hebert

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background: Therapy with intravenous unfractionated heparin improves clinical outcome in patients with active thromboembolic disease, but achieving and maintaining a therapeutic level of anticoagulation remains a major challenge for clinicians. Methods A total of 113 patients requiring heparin for at least 48 hours were randomly assigned at 7 medical centers to either weight-adjusted or non-weight-adjusted dose titration. They were separately assigned to either laboratory-based or point-of-care (bedside) coagulation monitoring. Results: Weight-adjusted heparin dosing yielded a higher mean activated partial thromboplastin time (aPTT) value 6 hours after treatment initiation than non-weight-adjusted dosing (99.9 vs 78.8 seconds; P = .002) and reduced the time required to exceed a minimum threshold (aPTT >45 seconds) of anticoagulation (10.5 vs 8.6 hours; P = .002). Point-of-care coagulation monitoring significantly reduced the time from blood sample acquisition to a heparin infusion adjustment (0.4 vs 1.6 hours; P < .0001) and to reach the therapeutic aPTT range (51 to 80 seconds) [16.1 vs 19.4 hours; P = .24) compared with laboratory monitoring. Although a majority of patients participating in the study surpassed the minimum threshold of anticoagulation within the first 12 hours and reached the target aPTT within 24 hours, maintaining the aPTT within the therapeutic range was relatively uncommon (on average 30% of the overall study period) and did not differ between treatment or monitoring strategies. Conclusions: Weight-adjusted heparin dosing according to a standardized titration nomogram combined with point-off care coagulation monitoring using the BMC Coaguchek Plus System represents an effective and widely generalizable strategy for managing patients with thromboembolic disease that fosters the rapid achievement of a desired range of anticoagulation. Additional work is needed, however, to improve on existing patient-specific strategies that can more effectively sustain a therapeutic state of anticoagulation.

Original languageEnglish
Pages (from-to)59-71
Number of pages13
JournalAmerican Heart Journal
Volume137
Issue number1
DOIs
StatePublished - Jan 25 1999
Externally publishedYes

Fingerprint

Point-of-Care Systems
Multicenter Studies
Heparin
Partial Thromboplastin Time
Weights and Measures
Therapeutics
Social Adjustment
Nomograms

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease. / Becker, Richard C.; Ball, Steven P.; Eisenberg, Paul; Borzak, Steven; Christian Held, A.; Spencer, Frederick; Voyce, Stephen J.; Jesse, Robert; Hendel, Robert; Ma, Yunsheng; Hurley, Thomas; Hebert, James.

In: American Heart Journal, Vol. 137, No. 1, 25.01.1999, p. 59-71.

Research output: Contribution to journalArticle

Becker, RC, Ball, SP, Eisenberg, P, Borzak, S, Christian Held, A, Spencer, F, Voyce, SJ, Jesse, R, Hendel, R, Ma, Y, Hurley, T & Hebert, J 1999, 'A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease', American Heart Journal, vol. 137, no. 1, pp. 59-71. https://doi.org/10.1016/S0002-8703(99)70460-6
Becker, Richard C. ; Ball, Steven P. ; Eisenberg, Paul ; Borzak, Steven ; Christian Held, A. ; Spencer, Frederick ; Voyce, Stephen J. ; Jesse, Robert ; Hendel, Robert ; Ma, Yunsheng ; Hurley, Thomas ; Hebert, James. / A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease. In: American Heart Journal. 1999 ; Vol. 137, No. 1. pp. 59-71.
@article{7e0490cd4c1b45db85e46375015112cc,
title = "A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease",
abstract = "Background: Therapy with intravenous unfractionated heparin improves clinical outcome in patients with active thromboembolic disease, but achieving and maintaining a therapeutic level of anticoagulation remains a major challenge for clinicians. Methods A total of 113 patients requiring heparin for at least 48 hours were randomly assigned at 7 medical centers to either weight-adjusted or non-weight-adjusted dose titration. They were separately assigned to either laboratory-based or point-of-care (bedside) coagulation monitoring. Results: Weight-adjusted heparin dosing yielded a higher mean activated partial thromboplastin time (aPTT) value 6 hours after treatment initiation than non-weight-adjusted dosing (99.9 vs 78.8 seconds; P = .002) and reduced the time required to exceed a minimum threshold (aPTT >45 seconds) of anticoagulation (10.5 vs 8.6 hours; P = .002). Point-of-care coagulation monitoring significantly reduced the time from blood sample acquisition to a heparin infusion adjustment (0.4 vs 1.6 hours; P < .0001) and to reach the therapeutic aPTT range (51 to 80 seconds) [16.1 vs 19.4 hours; P = .24) compared with laboratory monitoring. Although a majority of patients participating in the study surpassed the minimum threshold of anticoagulation within the first 12 hours and reached the target aPTT within 24 hours, maintaining the aPTT within the therapeutic range was relatively uncommon (on average 30{\%} of the overall study period) and did not differ between treatment or monitoring strategies. Conclusions: Weight-adjusted heparin dosing according to a standardized titration nomogram combined with point-off care coagulation monitoring using the BMC Coaguchek Plus System represents an effective and widely generalizable strategy for managing patients with thromboembolic disease that fosters the rapid achievement of a desired range of anticoagulation. Additional work is needed, however, to improve on existing patient-specific strategies that can more effectively sustain a therapeutic state of anticoagulation.",
author = "Becker, {Richard C.} and Ball, {Steven P.} and Paul Eisenberg and Steven Borzak and {Christian Held}, A. and Frederick Spencer and Voyce, {Stephen J.} and Robert Jesse and Robert Hendel and Yunsheng Ma and Thomas Hurley and James Hebert",
year = "1999",
month = "1",
day = "25",
doi = "10.1016/S0002-8703(99)70460-6",
language = "English",
volume = "137",
pages = "59--71",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease

AU - Becker, Richard C.

AU - Ball, Steven P.

AU - Eisenberg, Paul

AU - Borzak, Steven

AU - Christian Held, A.

AU - Spencer, Frederick

AU - Voyce, Stephen J.

AU - Jesse, Robert

AU - Hendel, Robert

AU - Ma, Yunsheng

AU - Hurley, Thomas

AU - Hebert, James

PY - 1999/1/25

Y1 - 1999/1/25

N2 - Background: Therapy with intravenous unfractionated heparin improves clinical outcome in patients with active thromboembolic disease, but achieving and maintaining a therapeutic level of anticoagulation remains a major challenge for clinicians. Methods A total of 113 patients requiring heparin for at least 48 hours were randomly assigned at 7 medical centers to either weight-adjusted or non-weight-adjusted dose titration. They were separately assigned to either laboratory-based or point-of-care (bedside) coagulation monitoring. Results: Weight-adjusted heparin dosing yielded a higher mean activated partial thromboplastin time (aPTT) value 6 hours after treatment initiation than non-weight-adjusted dosing (99.9 vs 78.8 seconds; P = .002) and reduced the time required to exceed a minimum threshold (aPTT >45 seconds) of anticoagulation (10.5 vs 8.6 hours; P = .002). Point-of-care coagulation monitoring significantly reduced the time from blood sample acquisition to a heparin infusion adjustment (0.4 vs 1.6 hours; P < .0001) and to reach the therapeutic aPTT range (51 to 80 seconds) [16.1 vs 19.4 hours; P = .24) compared with laboratory monitoring. Although a majority of patients participating in the study surpassed the minimum threshold of anticoagulation within the first 12 hours and reached the target aPTT within 24 hours, maintaining the aPTT within the therapeutic range was relatively uncommon (on average 30% of the overall study period) and did not differ between treatment or monitoring strategies. Conclusions: Weight-adjusted heparin dosing according to a standardized titration nomogram combined with point-off care coagulation monitoring using the BMC Coaguchek Plus System represents an effective and widely generalizable strategy for managing patients with thromboembolic disease that fosters the rapid achievement of a desired range of anticoagulation. Additional work is needed, however, to improve on existing patient-specific strategies that can more effectively sustain a therapeutic state of anticoagulation.

AB - Background: Therapy with intravenous unfractionated heparin improves clinical outcome in patients with active thromboembolic disease, but achieving and maintaining a therapeutic level of anticoagulation remains a major challenge for clinicians. Methods A total of 113 patients requiring heparin for at least 48 hours were randomly assigned at 7 medical centers to either weight-adjusted or non-weight-adjusted dose titration. They were separately assigned to either laboratory-based or point-of-care (bedside) coagulation monitoring. Results: Weight-adjusted heparin dosing yielded a higher mean activated partial thromboplastin time (aPTT) value 6 hours after treatment initiation than non-weight-adjusted dosing (99.9 vs 78.8 seconds; P = .002) and reduced the time required to exceed a minimum threshold (aPTT >45 seconds) of anticoagulation (10.5 vs 8.6 hours; P = .002). Point-of-care coagulation monitoring significantly reduced the time from blood sample acquisition to a heparin infusion adjustment (0.4 vs 1.6 hours; P < .0001) and to reach the therapeutic aPTT range (51 to 80 seconds) [16.1 vs 19.4 hours; P = .24) compared with laboratory monitoring. Although a majority of patients participating in the study surpassed the minimum threshold of anticoagulation within the first 12 hours and reached the target aPTT within 24 hours, maintaining the aPTT within the therapeutic range was relatively uncommon (on average 30% of the overall study period) and did not differ between treatment or monitoring strategies. Conclusions: Weight-adjusted heparin dosing according to a standardized titration nomogram combined with point-off care coagulation monitoring using the BMC Coaguchek Plus System represents an effective and widely generalizable strategy for managing patients with thromboembolic disease that fosters the rapid achievement of a desired range of anticoagulation. Additional work is needed, however, to improve on existing patient-specific strategies that can more effectively sustain a therapeutic state of anticoagulation.

UR - http://www.scopus.com/inward/record.url?scp=0032938044&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032938044&partnerID=8YFLogxK

U2 - 10.1016/S0002-8703(99)70460-6

DO - 10.1016/S0002-8703(99)70460-6

M3 - Article

VL - 137

SP - 59

EP - 71

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 1

ER -