2018 Research Forum

Weight-based dosing vs standard care nomogram for IV heparin Presenter & Principal Investigator: Jasmine Ho PharmD Faculty Sponsor: Jeff Jolliff PharmD BCPS BCACP AAHIVP CDE

Jasmine Ho PharmD 1 , Nadia Moghim PharmD 2 , Jeff Jolliff PharmD 3 , Jessica Beck PharmD 4 1 Resident Pharmacist R1 2 Clinical Pharmacist 3 Clinical Pharmacy Residency Program Director; Adjunct Professor of Pharmacy Practice, University of the Pacific 4 Director, Pharmacy Services INTRODUCTION Unfractionated heparin is a high-alert medication due to its significant risk of causing life-threatening bleeding or thrombosis. Since heparin is a high-alert medication, cautious monitoring, prescribing, and administering of the medication are important in preventing fatal adverse events. Kern Medical has two heparin protocols: venous thromboembolism and acute coronary syndrome. The protocols provide targeted therapeutic range, dosing, and monitoring parameters. Prior to 2016, heparin dosing was based on standard care nomogram. However, studies showed that weight-based nomogram may be more effective. In July 2017, a new heparin protocol was implemented with changes for weight-based dosing. This study aims to assess the efficacy of weight-based dosing for IV heparin compared to the standard care nomogram. PURPOSE To evaluate the effectiveness of weight-based dosing compared to the standard care nomogram for unfractionated heparin. METHOD For standard care nomogram, 30 charts were retrospectively reviewed from January 2016 to June 2016. For weight-based nomogram, 23 charts were retrospectively reviewed fromJuly 2017 toNovember 2017. Exclusion criteria include different target aPTTs, indications not in protocol, lack of documentation, and discontinuation after one dose. The results of the time in therapeutic range and time to first therapeutic aPTT will be compared. RESULTS Standard care (N=30) Weight-based (N=23) Total hours on drip (Mean) 60.6 (14-283) 52.98 (6-236.5) Total hours therapeutic on drip (Mean) 29.8 (0-128) 41.5% 32.45 (0-160.17) 57.0% Mean time to first therapeutic aPTT (hours) 16.4 (3-79) 13.28 (6-32) DISCUSSION The total therapeutic hours on heparin drip was greater in weight-based nomogram than the standard care. Weight-based dosing had less time to first therapeutic aPTT compared to standard care. Because the weight-based dosing protocol did not have education campaign, some IV heparins were incorrectly administered, which could have influenced the data. Statistical analysis could not be performed. Safety measures was also not measured. CONCLUSIONS Weight-basednomogramhas greater total hours in therapeuticaPTTand took less time tofirst therapeutic aPTT on heparin drip compared to the standard care nomogram. More studies and statistical analysis needs to be done in order to compare the nomograms.

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