Key result
An initial heparin dose of 100 IU/kg during noncardiac arterial procedures achieved an activated clotting time of 200 s in 78% of patients and 250 s in 46% of patients.
Why the study?
Standardized heparin boluses during noncardiac arterial procedures frequently fail to achieve adequate activated clotting time, motivating investigation into whether initial weight-based dosing provides adequate and safe anticoagulation.
Does an initial unfractionated heparin dose of 100 IU/kg achieve an adequate and safe ACT in patients undergoing noncardiac arterial procedures?
Cohort (n=186)
Yes
Does an initial unfractionated heparin dose of 100 IU/kg achieve an adequate and safe ACT in patients undergoing noncardiac arterial procedures?
Answers are grounded in this paper and cite their sources.
100 IU/kg heparin may not achieve target ACT in many patients; leaves open optimal dosing for noncardiac arterial procedures.
BACKGROUND: Unfractionated heparin has an unpredictable effect in an individual patient. The activated clotting time (ACT) can be used to measure the effect of heparin in the individual patient and guide additional heparin dosages. Previous cohort studies showed that a standardized bolus of 5,000 IU during noncardiac arterial procedures (NCAP) does not lead to an adequate ACT in the vast majority of patients. The aim of this study was to investigate whether an initial heparin dose of 100 IU/kg leads to an adequate but safe ACT, from 200 to 300 s. METHODS: In this multicenter prospective study, 186 patients undergoing NCAP were enrolled and received an initial heparin dose of 100 IU/kg. Target ACT was set at ≥250 s initially; during the course of the study the target ACT was lowered to ≥200 s. After the initial heparin dose, additional heparin dosages were administered depending on the ACT values following a heparin dose protocol. ACT measurements and complications were monitored. RESULTS: The mean baseline ACT was 134 ± 17 s. The mean ACT 5 minutes after the initial heparin dose was 227 ± 37 s. After the initial dose of heparin, 78 and 46% of patients reached an ACT of 200 and 250 s, respectively. Seven patients (4%) reached an ACT of 300 s or more. Ninety-four patients (51%) received at least one additional dose of heparin. After one additional dose of heparin, 91% of patients reached an ACT of 200 s and 13 patients (7%) reached an ACT of 300 s or more. Arterial thromboembolic complications occurred in 4.3% and bleeding complications occurred in 9.7%. CONCLUSIONS: A bolus of 100 IU/kg of heparin during NCAP results in adequate coagulation in most patients. ACT measurements enable accurate additional dosing, ensuring the individual patient tailored and safe coagulation.
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Doganer et al. (2022) conducted a cohort in Noncardiac arterial procedures (n=186). Heparin was evaluated on Activated clotting time (ACT) of 200 s after initial heparin dose. An initial heparin dose of 100 IU/kg during noncardiac arterial procedures achieved an activated clotting time of 200 s in 78% of patients and 250 s in 46% of patients.
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