Key result
Initial heparin bolus shows no benefit over infusion alone for achieving therapeutic anti-Xa levels.
Why the study?
Prior data showed most patients treated with unfractionated heparin for pulmonary embolism failed to maintain therapeutic aPTT levels within 48 hours, prompting evaluation of an institutional protocol using anti-Xa monitoring.
Does an initial bolus of unfractionated heparin plus infusion compared to infusion alone affect the achievement of therapeutic anti-Xa levels in adult patients with venous thromboembolism?
Cohort (n=205)
No
Does an initial bolus of unfractionated heparin plus infusion compared to infusion alone affect the achievement of therapeutic anti-Xa levels in adult patients with venous thromboembolism?
Absolute Event Rate: 96.6% vs 98.3%
p-value: p=0.65
Most patients achieved a therapeutic anti-Xa level within 48 hours using the unfractionated heparin dosing protocol, but maintaining consistent therapeutic levels remains a clinical challenge regardless of initial bolus use.
High therapeutic anti-Xa achievement supports current heparin protocols in VTE; leaves open bolus role and maintenance strategies.
Background: A 2019 study by Prucnal and colleagues found that the majority of patients treated with unfractionated heparin for pulmonary embolism did not maintain therapeutic activated partial thromboplastin time levels during the first 48 h of therapy. Objective: The purpose of this study was to evaluate the ability of an institution’s unfractionated heparin dosing protocol to achieve and maintain therapeutic anti-Xa levels within the first 48 h of therapy in patients with venous thromboembolism. Methods: This retrospective study included 205 patients from May 2016 through September 2020. Patients were divided into two cohorts: bolus plus infusion ( N = 89) and infusion only ( N = 116). The primary objective was to determine the number of patients who achieved at least one therapeutic level. Results: Overall, 200 patients (97.6%) had at least one therapeutic level with no statistically significant difference between cohorts ( p = 0.65). No more than 60% of patients achieved a therapeutic level at any of the 6-h intervals throughout the timeframe. The median time to the first therapeutic level in the overall group was 12.8 h with no statistically significant difference between the bolus plus infusion and infusion-only cohorts (13.3 h versus 12.7 h, respectively, p = 0.48). Conclusions: Most patients were able to achieve at least one therapeutic level within the first 48 h, but fewer were able to maintain therapeutic levels. Further studies are warranted to determine whether alternative dosing strategies would yield consistent achievement of therapeutic levels and affect patient-oriented outcomes.
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Nguyen et al. (2023) conducted a cohort in Venous thromboembolism (n=205). Unfractionated heparin bolus plus continuous infusion vs. Unfractionated heparin continuous infusion only was evaluated on Achievement of at least one therapeutic heparin anti-Xa level within the first 48 h (p=0.65). Most patients (97.6%) achieved at least one therapeutic anti-Xa level within 48 hours, with no significant difference between the bolus plus infusion and infusion-only cohorts (96.6% vs 98.3%, p=0.65).
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