RASCHKE

Weight-based heparin dosing nomogram compared with a “standard care” nomogram (1993)

Condition

Venous or arterial thromboembolism or unstable angina

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Objective

To determine, whether a weight-based approach achieves therapeutic anticoagulation with heparin more rapidly than a standard approach

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Trial design

Randomized, controlled study with parallel groups
Active treatment: weight-based heparin (i.v. bolus of 80 IU/kg followed by continuous infusion of 18 IU/kg/hour for at least 48 hours, in which no oral anticoagulant was administered (n=62)
Control treatment: standard heparin regimen (i.v. bolus of 5.000 IU, followed by continuous infusion of 1.000 IU/hour for at least 48 hours, in which no oral anticoagulant was administered (n=53)

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Endpoints

Primary endpoints: time to exceed the therapeutic threshold (aPTT 1.5 times the control) and time to achieve the therapeutic range (aPTT 1.5–2.3 times the control); documented symptomatic extension of VTE, symptomatic PE or VTE recurrence during a 6-months follow-up
Secondary endpoints: major and minor hemorrhages during hospital stay, thromboembolic recurrences at 3 months in VTE-patients

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Trial participants

115 patients with DVT or PE (n=85), unstable angina (n=26) and acute peripheral arterial ischemia (n=2)

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Results

Primary outcome: The mean time required to exceed the therapeutic threshold was 8.2 hours in the weight-based group and 20.2 hours in the standard-care group. 60 of 62 patients (97%) in the weight-based group exceeded the therapeutic threshold within 24 hours, compared to 37 of 48 patients (77%) in the standard care group (p<0.002). The mean time before an aPTT value within the therapeutic range was reached, was 14.1 hours in the weight-based group and 22.3 hours in the standard care group
Secondary outcomes: Major bleeding occurred in 0 of 63 patients in the weight-based group and in 1 of 52 patients in the standard group. Minor bleeding complications were observed in 2 patients in each group. 8 of 32 VTE-patients (25%) had recurrent VTE compared to 2 of 41 patients (5%) in the standard care group

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Summary

Primary outcome: The weight-based heparin strategy achieved both primary outcomes (aPTT exceeding the therapeutic threshold and aPTT within the therapeutic range) significantly more rapidly as compared with the standard approach
Secondary outcomes: Recurrent thromboembolism was more frequent in the standard care group. The incidence of bleeding complications was comparable in both groups

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Reference

Raschke RA, Reilly BM, Guidry JR, Fontana JR, Srinivas S. The weight-based heparin dosing nomogram compared with a “standard care” nomogram. Ann Intern Med 1993;119:874-881

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Corresponding author

Robert A. Raschke, MD, Department of Medicine, Good Samaritan Regional Medical Center, 1111 E. McDowell Road, Phoenix, AZ 85006

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