Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Goodman and colleagues raise the issue of variable pharmacokinetics for unfractionated heparin. We agree that defining excessive dosing of unfractionated heparin is a challenge on several fronts, and accordingly set the cutpoints for excess unfractionated heparin purposefully high. In terms of an association between excess unfractionated heparin and bleeding events, it is likely that clinician adjustment of heparin dose based on aPTT results ameliorated the relationship between the initial dose and bleeding.
Alexander KP, Peterson ED. Excess Dosing of Antithrombotic Therapy in Non–ST-Segment Elevation Acute Coronary Syndromes—Reply. JAMA. 2006;295(16):1896-1897. doi:10.1001/jama.295.16.1897-b