Unfractionated heparin, time for a change?

Background: In Ireland physician transfer to utilisation of Low Molecular W eight Heparin for Venous Thromboembolism has been slow, despite evidence of efficacy and concern about the level of anticoagulation achieved with Unfr actionated Heparin. Objective: To examine the effectiveness of Unfractionated Heparin administr ation in a teaching hospital in Ireland. Primary outcomes measured were tim e to therapeutic APTT and length of hospital stay. Methods: We identified 50 consecutive eligible patients treated with contin uous intravenous unfractionated heparin for Venous Thromboembolism from the period August 1994 to December 1996 at Beaumont Hospital, Dublin, Ireland. Data analysed included length of hospital stay, costing data and anticoagu lation parameters (time to therapeutic APTT, percentage of time within ther apeutic range, number of diagnostic tests, heparin dosages). Results: A significant number of patients (22%) never achieved therapeutic APTT levels. Of those who did achieve therapeutic APTT levels at some time during their therapy, therapeutic range APTT was maintained only 28% of the time on heparin. 57% of the time results mere below therapeutic while 15% of the time results were above therapeutic. Also 26% of the patients were d ischarged with INR results outside the therapeutic range despite an average length of stay of 13.3 days (over twice the ideal of 6 days). Ineffective anticoagulation influenced hospital length of stay in 60% of cases in our e valuation. Average cost of treatment with Unfractionated Heparin was pound 5897.86 versus the projected cost of Low Molecular Weight Heparin at pound 2562.78 for 6 days of in-patient therapy or pound 60.78 for outpatient ther apy (excluding physician visit costs). Conclusions: Unfractionated Heparin therapy as reviewed in our study is sub -optimal with inadequate anti coagulation and prolonged hospitalisation. Lo w Molecular Weight heparin, with comparable therapeutic effect documented e lsewhere, overall may cost less. Acknowledgement: Funding for this study was received from Leo Laboratories, Ireland.