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However, many baseline patient characteristics e. This higher risk of bleeding in patients receiving the LI protocol also likely explains the increased incidence of bleeding when compared to the SI protocol. In conclusion, a LI protocol may have comparable efficacy to a SI protocol based on the similar incidence of new or worsening thrombus.

This is of notable importance in patients at high risk for bleeding. In the future, a prospective randomized trial of both protocols matched for comorbidities, risk factors, and indications is needed to further elaborate on the findings of this study with the ultimate goal of developing a risk stratification scoring system and weight-based dosing nomogram for use by clinicians. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein.

All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist. Consent was obtained by all participants in this study.

University of Florida IRB issued approval IRB approval, project number for retrospective chart review. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. National Center for Biotechnology Information , U. Journal List Cureus v.

Published online May Author information Article notes Copyright and License information Disclaimer. Corresponding author. Forat Lutfi moc. Received May 7; Accepted May This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract Intravenous unfractionated heparin UFH remains one of the most commonly used anticoagulants in the hospital setting. Keywords: anticoagulant therapy, heparin, thrombosis, hemorrhage, venous thromboembolism. Introduction Since the discovery of heparin by Howell in and its initial use on human subjects in , it has been one of the most commonly utilized inpatient medications in modern medicine [ 1 , 2 ]. Materials and methods A total of adult patients receiving therapeutic UFH from July to July at a single tertiary academic center were retrospectively studied.

Table 1 Nursing protocol for therapeutic infusion of unfractionated heparin UFH Note: heparin unfractionated levels are obtained six hours from initiation of the infusion and then checked every six hours until therapeutic on two consecutive measurements. Open in a separate window. Results Of the patients studied, Table 3 Bleeding and thrombosis while on therapeutic heparin UFH: unfractionated heparin.

Conclusions In conclusion, a LI protocol may have comparable efficacy to a SI protocol based on the similar incidence of new or worsening thrombus. Human Ethics Consent was obtained by all participants in this study. Animal Ethics Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. References 1. Drug Discovery: Practices, Processes, and Perspectives. Antithrombotic therapy for venous thromboembolic disease.

Ann Intern Med. Comparison of a weight-based heparin nomogram with traditional heparin dosing to achieve therapeutic anticoagulation. Reevaluation of a weight-based heparin dosing nomogram: is institution-specific modification necessary?

Ann Pharmacother. Weight-based heparin dosing: clinical response and resource utilization. Clin Ther. Prevention of venous thromboembolism. Partnering with nurses to manage heparin therapy with a weight-based protocol. Price CK, Colodny L. Am J Health Syst Pharm. An institution-specific heparin titration nomogram: development, validation, and assessment of compliance. Introduction to the ninth edition: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines.

Challenges in variation and responsiveness of unfractionated heparin. Laboratory monitoring of heparin therapy: partial thromboplastin time or anti-Xa assay? Lab Med. Anticoagulant failure in coagulopathic patients: PTT confounding and other pitfalls. Warkentin TE. Expert Opin Drug Saf. A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin.

Arch Intern Med. Monitoring unfractionated heparin therapy with antifactor Xa activity results in fewer monitoring tests and dosage changes than monitoring with the activated partial thromboplastin time.

Rosborough TK. Activated partial thromboplastin time versus antifactor Xa heparin assay in monitoring unfractionated heparin by continuous intravenous infusion. Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH. J Thromb Haemost. Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis.

N Engl J Med. The use of anti-xa assay to monitor intravenous unfractionated heparin therapy. J Pharm Pract. Establishing a therapeutic range for heparin therapy. Weight-based heparin protocol using antifactor Xa monitoring. Am J Heal Pharm. A review of unfractionated heparin and its monitoring. Tahir R. A standard heparin nomogram for the management of heparin therapy. Articles from Cureus are provided here courtesy of Cureus Inc.

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