We agree with Le Bras and Halfon that the reported improvement in therapeutic efficacy in our study1 may not only have been a result of the heparin nomogram, but it also could have resulted from a difference in the initial heparin dose between study patients and control patients. The comparison between nomogram and control was not randomized, and, therefore, the differences could be caused by multiple factors.We also agree that it is important for each center to develop both a standardized initial dosage for the first 6 hours and a standardized method for subsequent dose adjustments.
Levine MN. Standardization of Heparin Therapy Improves Efficacy-Reply. Arch Intern Med. 1992;152(10):2413. doi:10.1001/archinte.1992.00400220142029