THE SUCCESSFUL APPLICATION OF A HEPARIN NOMOGRAM IN A COMMUNITY-HOSPITAL

Background: Heparin administration by physicians can vary greatly, and this variance can result in ineffective anticoagulation and reduced e ffectiveness of treatment. Objective: To examine the use of a heparin nomogram in two community hospitals to validate its effect on anticoag ulation parameters and to determine its influence on length of hospita l stay. Methods: Prenomogram and postnomogram intervention in two comm unity hospitals in Sudbury, Ontario. All patients who presented and we re admitted to the hospitals between 1991 and 1994 with a confirmed pr imary diagnosis of deep vein thrombosis and/or pulmonary embolism were eligible for the study. A heparin nomogram was instituted in April 19 93 for treatment of deep vein thrombophlebitis and pulmonary embolism in hospitalized patients. The study patients were designated as prenom ogram or postnomogram. Anticoagulation parameters (time to therapeutic activated partial thromboplastin time), number of diagnostic tests, p ercentage of times within the therapeutic range, and length of hospita l stay were recorded for both groups. Results: A total of 326 patients were identified from the database; 163 (50%) met the inclusion criter ia. Patients in both groups appeared to be similar. Adequate anticoagu lation was achieved faster (17.9 hours postnomogram vs 48.8 hours pren omogram; P<.001) and remained subtherapeutic less frequently in the po stnomogram group (number of activated partial thromboplastin time test s below the therapeutic window; 56% prenomogram vs 28% postnomogram; P <.001). There were no differences between the groups with respect to l ength of stay (11.3 days prenomogram vs 10.9 days postnomogram; P=.60) . More activated partial thromboplastin time tests were ordered in the postnomogram group (15.6 postnomogram vs 12.7 prenomogram; P=.001); h owever, fewer prothrombin time tests were ordered in the postnomogram group. Conclusions: A heparin nomogram was successfully used in a comm unity hospital without a structured hematology-thrombosis service. The rapeutic anticoagulation was achieved faster and maintained more frequ ently, with less logistical problems, with this protocol. However, add itional measures may be required to reduce the length of hospital stay .