Nomograms for the administration of unfractionated heparin in the initial treatment of acute thromboembolism - an overview

Despite the availability of low-molecular-weight heparins, unfractionated h eparin (UFH) still remains the drug of choice for the initial treatment of acute venous thromboembolism in many countries. When appropriately employed , UFH treatment results in a degree of efficacy and safety that is fully co mparable with that obtained with the use of heparin derivatives. The use of nomograms for the intravenous or subcutaneous administration of UFH assure s that virtually all patients will promptly achieve adequate levels of anti coagulation, thus decreasing the likelihood of recurrent venous thromboembo lism without extra bleeding-risk. In this article we reviewed clinical studies on the implementation and vali dation of UFH dosing nomograms, and attempted a quantitative analysis of th eir performance. According to the results. of our analysis, a statistically significantly higher proportion of patients treated on the basis of a nomo gram reached a therapeutic anticoagulant level within 24 h of treatment, as compared to patients treated following the standard practice (odds ratio, 3.6; 95% CI, 2.6 to 4.9). The rate of recurrent thromboembolic events was s ignificantly lower for patients treated according to a nomogram (odds ratio , 0.3; 95% CI, 0.1 to 0.8), while no significant differences in terms of ei ther major or minor bleedings were detected between nomogram patients and c ontrols.