Prospective trial demonstrates continuous intravenous heparin infusion reduces major bleeding compared to intermittent injection, indicating a safer delivery method for anticoagulation.
Key Points
Evaluate the safety, efficacy, and monitoring strategies associated with continuous intravenous heparin infusion compared to intermittent intravenous injection.
Assessed bleeding and recurrent thromboembolism incidence in an initial cohort of 100 consecutive patients receiving therapeutic heparin with or without whole-blood clotting time monitoring.
Conducted a prospective trial comparing continuous intravenous heparin infusion against intermittent intravenous injection with or without partial thromboplastin time monitoring.
In the initial 100-patient series, major bleeding occurred in 21% of patients with clotting-time regulation and 20% without testing; 2 patients died from bleeding and 2 developed recurrent pulmonary embolism.
In the prospective trial, major bleeding occurred seven times more frequently with intermittent injections than with continuous infusion, while recurrent thromboembolism occurred once in each treatment group.
Continuous infusion required 25% less heparin than intermittent injection, and monitoring partial thromboplastin time failed to prevent major bleeding during intermittent dosing.