The Importance of Initial Heparin Treatment on Long-term Clinical Outcomes

In reply

We understand Shojania's concern about the medical/legal implications of inadequate heparin therapy. We agree that physicians should not be considered at fault if they follow heparin nomograms validated by clinical trials. For this reason, we state in our companion article¹ that

. . . even with the best of care using a heparin protocol, some patients treated with intravenous heparin will receive sub-therapy. In this context, sub-therapy reflects a practical limitation of the use of unfractionated heparin, rather than a poor standard of care.