BEDSIDE COAGULATION MONITORING IN HEPARIN-TREATED PATIENTS WITH ACTIVE THROMBOEMBOLIC DISEASE - A CORONARY-CARE UNIT EXPERIENCE

Patients with active venous and arterial thromboembolic disorders are known to benefit from systemic anticoagulation with heparin. Clinical studies have shown, however, that therapeutic anticoagulation is rarel y achieved rapidly and often is not maintained over time. Prolonged la boratory turnaround time of the activated partial thromboplastin time (aPTT) may contribute directly to these common problems. A total of 27 2 aPTT determinations were performed on 120 heparin-treated patients a dmitted to the coronary care unit. The time from sample collection to data availability was 126 +/- 84 minutes with standard laboratory aPTT testing. In contrast, a bedside coagulation device provided an aPTT w ithin 3 minutes (p < 0.001). Subtherapeutic aPTT values (<65 seconds) were documented in 21% of all patients; in each, the heparin dose was changed and a repeat aPTT was required. In a separate study of 33 hepa rinized patients randomized to either bedside or central laboratory aP TT testing (264 aPTT determinations), the time to achieve a therapeuti c state of systemic anticoagulation was 8.2 hours and 18.1 hours, resp ectively (p < 0.005). The time from aPTT determination to a decision r egarding heparin titration adjustments was 14.5 minutes and 3 hours wi th bedside and laboratory testing, respectively (p < 0.001). Thus beds ide coagulation monitoring provides a convenient, rapid, and accurate assessment of systemic anticoagulation among heparin-treated patients with active thromboembolic disease in the coronary care unit. This tec hnology warrants further clinical investigation.