Intravenous heparin dosing - Patterns and variations in internists' practices

Brendan M. Reilly, Robert Raschke, Sandhya Srinivas, Theresa Nieman

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Objective: To characterize internists' dosing practices when administering and adjusting intravenous heparin regimens. Design: A survey administered by physician-investigators. Setting: Two community teaching hospitals and one Veterans Affairs Medical Center. Subjects: Sixty-one attending physicians in internal medicine. Measurements: Physicians' choices of therapeutic activated partial thromboplastin time (APTT) range, initial heparin bolus, initial infusion dose, and dose/infusion adjustments when APTT levels are <1.2× control (<35 seconds), 1.2-1.5× control (35-45 seconds), 1.5-2.3× control (46-70 seconds), 2.3-3.0× control (71-90 seconds), and >30× control (>90 seconds). Results: Physicians' dosing decisions and therapeutic ranges during heparin treatment varied widely. Responses to nontherapeutic APTT levels had especially high coefficients of variation (0.67 - 0.81). Two groups of physicians, together comprising a majority of all respondents, use mutually exclusive therapeutic ranges (mean 44-56 seconds and 60-83 seconds). These two groups differ significantly in several types of dosing decisions. Conclusion: In the absence of generalizable standard guidelines for intravenous heparin therapy, internists' dosing practices vary widely. Because such practices may impede timely, effective anticoagulation, experimental studies comparing standardized dosing protocols are needed.

Original languageEnglish (US)
Pages (from-to)536-542
Number of pages7
JournalJournal of General Internal Medicine
Volume8
Issue number10
DOIs
StatePublished - Oct 1993
Externally publishedYes

Keywords

  • anticoagulation
  • heparin
  • internists
  • practice patterns

ASJC Scopus subject areas

  • Internal Medicine

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