Analyzing a Health-System's Use of Unfractionated Heparin to Ensure Optimal Anticoagulation

Background: Although unfractionated heparin (UH) dosing nomograms have proven to be superior to standard dosing, the latter remains the mainstay at our institution. We hypothesize that the incorporation of technology integrated with a decision support algorithm will facilitate the use of a UH nomogram by clinicians. Objective: To critically appraise the steps involved with the use of UH, create a decision support algorithm to aid in the management of UH, and determine whether the use of this algorithm can improve achievment of rapid and safe anticoagulation compared with the current standard of care. Methods: We analyzed the steps involved with the use of UH and subsequently reviewed the medical literature for risk factors for bleeding that patients may harbor when initiating UH. Based on this information, we designed a computerized physician order entry (CPOE), factor-based, weight-adjusted decision support algorithm with the primary goal of minimizing the risk of bleeding while optimizing and ensuring optimal anticoagulation. We compared the CPOE strategy with our current standard of care. Results: The CPOE factor–based dosing strategy significantly improved the rates and decreased the time to achieving an initial activated partial thromboplastin time (aPTT) that was ≥60 seconds compared with the control group. At the time of first aPTT measurement, the CPOE factor-based group achieved a 92.9% therapeutic rate compared with the standard heparin dosing group, which achieved a 60.8% therapeutic rate (p < 0.01). Conclusions: The institution of a CPOE factor-based dosing strategy in collaboration with pharmacists' interventions optimizes anticoagulation treatment with UH.