Category: Professional Posters
Purpose: The anticoagulant unfractionated Heparin (UH) is a high-risk drug used in the prevention and treatment of a variety of venous and thromboembolic disorders. It has a narrow therapeutic window with high inter- and intra-patient variability necessitating careful laboratory monitoring and dose adjustment to ensure proper antithrombotic protection while minimizing the bleeding risk. The objective of our study was to assess the appropriate use of UH in a tertiary care hospital in Beirut, Lebanon.
Methods: The medical charts of all patients admitted to the hospital and received UH between September 26 and November 30, 2018 were reviewed. We assessed the indication for UH, dosage, monitoring parameters, and possible side effects.
Results: During the study period, 24 patients received UH. Acute coronary syndrome (ACS), 9 patients (38%), was the most common indication, followed by atrial fibrillation, 6 patients (25%), deep venous thrombosis (DVT) prophylaxis, 5 patients (21 %), and pulmonary embolism, 1 patient (4%). Three patients (13%) received therapeutic doses of UH without documented indications in patients’ charts.
All patients received appropriate dosing for DVT prophylaxis. On the other hand, among the 19 patients receiving the drug for indications other than DVT prophylaxis, 15 patients (79%) did not receive a bolus dose, and 5 patients (26%) received inappropriate maintenance doses. Activated partial thromboplastin time (aPTT) was appropriately monitored in only 2 of the 19 patients (10.5%) and only 2 patients (10.5%) had a therapeutic aPTT after 24 hours of initiating UH.
Patient’s weight was not documented in 7 patients (29%). Four patients developed thrombocytopenia (platelet count < 100,000 /mm3) and one patient bled while receiving the drug. All patients had appropriate hemoglobin, hematocrit and platelet monitoring.
Conclusion: The use of UH was inappropriate in the majority of patients. This raises the need for appropriate application of the available protocols and emphasizes the role of pharmacists in drug monitoring.