Protocolized pharmacist intervention for critically elevated aPTT did not improve time in therapeutic range (62.4% vs 58.1%, P=0.467) but reduced BARC 2-5 bleeding (13.4% vs 23.2%, P<0.001).
Observational (n=277)
No
Does a protocolized pharmacist intervention improve time in therapeutic range and reduce bleeding in patients with critical aPTT values on heparin infusions?
Protocolized pharmacist intervention for critically elevated aPTT values during heparin infusions significantly reduced bleeding events, despite no significant change in time in therapeutic range.
Absolute Event Rate: 62.4% vs 58.1%
p-value: p=.467
Background: Unfractionated heparin (UFH) infusions are commonly managed with nurse-driven nomograms titrated to activated partial thromboplastin time (aPTT). In some patients, anti-Xa values may be more appropriate measures of anticoagulation. At the present institution, an update to the nurse-driven aPTT nomogram requires pharmacist notification and clinical assessment for critically supratherapeutic aPTT results. Objective: The purpose of this study was to evaluate the efficacy and safety of the nomogram update. Methods: A single-center, retrospective, pre-post analysis was conducted in patients treated with UFH who experienced a critical aPTT during the 6 months preceding and following the nomogram update. Patients with erroneous critical aPTT results were excluded. The primary endpoint was the time in therapeutic range (Rosendaal method) from the first critical aPTT until UFH discontinuation. Secondary endpoints included the proportion of patients transitioned to anti-Xa monitoring and the incidence of Bleeding Academic Research Consortium (BARC) 2, 3, 5 bleeding. Data were analyzed by the χ 2 test. The study was institutional review board approved. Results: Of 277 UFH infusions, 142 belonged to the pre-implementation group and 135 to the post-implementation group. Baseline aPTTs were similar between the 2 groups. Time in therapeutic range was 58.1% versus 62.4% of between groups ( P = .467). UFH was transitioned to pharmacist-driven anti-Xa monitoring in 16.2% versus 40.3% of patients ( P < .001). BARC 2, 3, 5 bleeding occurred in 23.2% versus 13.4% of patients ( P < .001). Conclusions: Application of these data suggest improved safety and efficacy outcomes with directed pharmacist management of UFH in patients with critically elevated aPTTs.
Barry et al. (Wed,) conducted a observational in Critically elevated aPTT during unfractionated heparin infusion (n=277). Protocolized pharmacist intervention vs. Nurse-driven aPTT nomogram (pre-implementation) was evaluated on Time in therapeutic range (Rosendaal method) from the first critical aPTT until UFH discontinuation (p=.467). Protocolized pharmacist intervention for critically elevated aPTT did not improve time in therapeutic range (62.4% vs 58.1%, P=0.467) but reduced BARC 2-5 bleeding (13.4% vs 23.2%, P<0.001).