To the Editor.—
We read with interest an article by Cruickshank et al1 on the management of heparin therapy. Analyzing the data, we found that the improvement of therapeutic efficacy may not only be due to the use of a nomogram but also to the difference between the mean initial heparin dose given to the study patients and to the control patients during the first 24 hours (32903 IU and 28 563 IU, respectively). Moreover, no data are available about the initial infusion rate in the control group.We carried out a similar study during the past years. The retrospective review of clinical records of 34 patients treated with intravenous heparin for deep-vein thrombosis and/or pulmonary embolism disclosed wide variations in clinical practices, such as absence of initial loading dose (bolus) in 60% of the cases, variation in the timing of the first activated partial thromboplastin time (APTT) measurement
Bras PL, Halfon P. Standardization of Heparin Therapy Improves Efficacy. Arch Intern Med. 1992;152(10):2140–2413. doi:10.1001/archinte.1992.00400220142028
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