A randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease

Background Therapy with intravenous unfractionated heparin improves clinica l outcome in patients with active thromboembolic disease, but achieving and maintaining a therapeutic level of anticoagulation remains a major challen ge for clinicians. Methods A total of 113 patients requiring heparin for at least 48 hours wer e randomly assigned at 7 medical centers to either weight-adjusted or non-w eight-adjusted dose titration. They were separately assigned to either labo ratory-based or point-of-care (bedside) coagulation monitoring. Results Weight-adjusted heparin dosing yielded a higher mean activated part ial thromboplastin time (aPTT) value 6 hours after treatment initiation tha n non-weight-adjusted dosing (99.9 vs 78.8 seconds; P = .002) and reduced t he time required to exceed a minimum threshold (aPTT >45 seconds) of antico agulation (10.5 vs 8.6 hours; P = .002). point-of-care coagulation monitori ng significantly reduced the time from blood sample acquisition to a hepari n infusion adjustment (0.4 vs 1.6 hours; P < .0001) and to reach the therap eutic aPTT range (51 to 80 seconds) (16.1 vs 19.4 hours; P = .24) compared with laboratory monitoring. Although a majority of patients participating i n the study surpassed the minimum threshold of anticoagulation within the f irst 12 hours and reached the target aPTT within 24 hours, maintaining the aPTT within the therapeutic range wets relatively uncommon (on average 30% of the overall study period) and did not differ between treatment or monito ring strategies. Conclusions Weight-adjusted heparin dosing according to a standardized titr ation nomogram combined with point-of care coagulation monitoring using the BMC Coaguchek plus System represents an effective and widely generalizable strategy for managing patients with thromboembolic disease that fosters th e rapid achievement of a desired range of anticoagulation. Additional work is needed, however, to improve on existing patient-specific strategies that can more effectively sustain a therapeutic state of anticoagulation.