Suboptimal Monitoring and Dosing of Unfractionated Heparin

Letters6 April 2004Suboptimal Monitoring and Dosing of Unfractionated HeparinRobert Raschke, MD, MS, Jack Hirsh, MD, and James R. Guidry, PharmDRobert Raschke, MD, MSFrom Good Samaritan Regional Medical Center, Phoenix, AZ 85006; Henderson Civic Hospital Research Center, Hamilton, Ontario L8V 1C3, Canada; and Desert Samaritan Medical Center, Mesa, AZ 85202.Search for more papers by this author, Jack Hirsh, MDFrom Good Samaritan Regional Medical Center, Phoenix, AZ 85006; Henderson Civic Hospital Research Center, Hamilton, Ontario L8V 1C3, Canada; and Desert Samaritan Medical Center, Mesa, AZ 85202.Search for more papers by this author, and James R. Guidry, PharmDFrom Good Samaritan Regional Medical Center, Phoenix, AZ 85006; Henderson Civic Hospital Research Center, Hamilton, Ontario L8V 1C3, Canada; and Desert Samaritan Medical Center, Mesa, AZ 85202.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-7-200404060-00031 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with the comments of Chung and colleagues. We have encountered similar problems and have devised practices for minimizing them. The most important are the development of a close working relationship between interested clinicians and laboratory personnel and proper implementation of standardized heparin order sheets. After years of practice, our coagulation laboratory staff have become adept at calibrating the therapeutic aPTT range for new thromboplastin reagents. We have experienced several major shifts in aPTT therapeutic ranges over the years: Our lowest calibrated range was 46 to 70 seconds, and our highest was 75 to 105 seconds. The ...References1. Raschke RA, Reilly BM, Guidry JR, Fontana JR, Srinivas S. The weight-based heparin dosing nomogram compared with a “standard care” nomogram. A randomized, controlled trial. Ann Intern Med. 1993;119:874-81. [PMID: 8214998] LinkGoogle Scholar2. Raschke RA, Gollihare B, Peirce JC. The effectiveness of implementing the weight-based heparin nomogram as a practice guideline. Arch Intern Med. 1996;156:1645-9. [PMID: 8694662] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Robert Raschke, MD, MS; Jack Hirsh, MD; James R. Guidry, PharmDAffiliations: From Good Samaritan Regional Medical Center, Phoenix, AZ 85006; Henderson Civic Hospital Research Center, Hamilton, Ontario L8V 1C3, Canada; and Desert Samaritan Medical Center, Mesa, AZ 85202. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Weight-based Heparin Dosing Nomogram Compared with a Standard Care Nomogram Robert A. Raschke , Brendan M. Reilly , James R. Guidry , Joseph R. Fontana , and Sandhya Srinivas Suboptimal Monitoring and Dosing of Unfractionated Heparin in Comparative Studies with Low-Molecular-Weight Heparin Robert Raschke , Jack Hirsh , and James R. Guidry Suboptimal Monitoring and Dosing of Unfractionated Heparin Kevin K. Chung , Jeanne K. Tofferi , and William T. Browne Metrics Cited byHeparin dosing and therapeutic activated partial thromboplastin times (aPTT) in acute coronary syndrome (ACS) 6 April 2004Volume 140, Issue 7Page: 582-583KeywordsClinical trialsHeparinPatientsResearch laboratories ePublished: 6 April 2004 Issue Published: 6 April 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...