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Use of an Algorithm for Administering Subcutaneous Heparin in the Treatment of Deep Venous Thrombosis

Paolo Prandoni, MD, PhD; Paola Bagatella, MD; Enrico Bernardi, MD; Bruno Girolami, MD; Laura Rossi, MD; Luigi Scarano, MD; Antonio Marchiori, MD; Andrea Piccioli, MD; and Antonio Girolami, MD
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From the University of Padua Medical School, Padua, Italy Requests for Reprints: Paolo Prandoni, MD, PhD, Institute of Medical Semeiotics, University of Padua Medical School, via Ospedale Civile, 105, 35128 Padua, Italy. Current Author Addresses: Drs. Prandoni, Bagatella, Bernardi, B. Girolami, Rossi, Scarano, Marchiori, Piccioli, and A. Girolami: Institute of Medical Semeiotics, University of Padua Medical School, via Ospedale Civile, 105, 35128 Padua, Italy.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(4):299-302. doi:10.7326/0003-4819-129-4-199808150-00006
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Background: Despite the widespread use of subcutaneous heparin in the initial treatment of deep venous thrombosis, there are no guidelines for achieving adequate anticoagulation with this drug.

Objective: To implement a weight-based algorithm for the administration of subcutaneous unfractionated heparin after an intravenous loading dose.

Design: Prospective cohort study.

Setting: University hospital.

Participants: 70 outpatients with proximal venous thrombosis.

Intervention: An intravenous bolus of heparin followed by a subcutaneous injection of heparin in doses adjusted for body weight. Subsequent adjustments of the subcutaneous heparin dose were scheduled twice daily according to the algorithm; the activated partial thromboplastin time (aPT) was measured in the mid-interval (target range, 50 to 90 seconds).

Results: The therapeutic threshold aPT (≥ 50 seconds) was achieved in 61 patients (87%) within 24 hours and in 69 patients (99%) within 48 hours. In 7 patients (10%), a supratherapeutic aPT lasted more than 12 hours. No major bleeding episodes or cases of heparin-induced thrombocytopenia were seen. Three patients (4.3% [95% CI, 0.9% to 12.0%]) had recurrent thromboembolism during 3 months of follow-up.

Conclusion: The administration of subcutaneous heparin according to a weight-based algorithm allows the rapid achievement of effective and safe anticoagulation in patients with deep venous thrombosis.


Grahic Jump Location
Figure 1.
Cumulative proportion of patients reaching the therapeutic threshold (activated partial thromboplastin time ≥ 50 seconds) within 48 hours of the initiation of heparin therapy.

The second row of numbers along the x-axis shows the number of patients with an activated partial thromboplastin time less than 50 seconds.

Grahic Jump Location




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