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SUPPLEMENT: Jack Hirsh and Robert Raschke Heparin and Low-Molecular-Weight Heparin: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest 2004; 126: 188S-203S [Abstract] [Full text] [PDF]

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Heparin Monitoring

Christine M. Smith, Pharm.D.   (6 October 2004)

Heparin Monitoring 6 October 2004
Christine M. Smith, Pharm.D., clinical pharmacist United Hospital System, Kenosha, WI Send letter to journal: Re: Heparin Monitoring christine.smith{at}uhsi.org Christine M. Smith, Pharm.D.	Thank you for highlighting so clearly the shortcomings of using aPTT for monitoring anticoagulant response to unfractionated heparin therapy. My institution has followed the recommendation that our therapeutic aPTT range is specifically calibrated for our instrument and reagent lot by correlation with therapeutic heparin levels as determined by factor Xa inhibition. After reagent lot specific calibration, supratherapeutic aPTT's raised concern, and for a short time heparin levels were performed simultaneous to the aPTT's. Heparin anti-factor Xa assays provide an alternative means of monitoring heparin therapy. Table 5--Weight-Based Nomogram has an omission that may be misleading for those unfamiliar with heparin dosing. Under the aPTT ranges of "<35 s" and "35-45 s," the dose column fails to state that the dose should be INCREASED BY 4 units/kg/hr or 2 units/kg/hr, respectively.