PMID- 35292499
OWN - NLM
STAT- MEDLINE
DCOM- 20220405
LR  - 20220524
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 12
IP  - 3
DP  - 2022 Mar 15
TI  - Improving safety of unfractionated heparin: a retrospective, quasi-experimental, 
      observational study of the impact of a pocket card and a computerised 
      prescription aid tool in the University Hospitals of Geneva.
PG  - e056912
LID - 10.1136/bmjopen-2021-056912 [doi]
LID - e056912
AB  - BACKGROUND: Despite the rapid rise of direct oral anticoagulants, unfractionated 
      heparin (UFH) remains the mainstay anticoagulant in specific situations such as 
      severe renal failure, perioperative setting or in critical care units. However, 
      its titration is often challenging. OBJECTIVES: To investigate the effect of a 
      pocket card and a computerised prescription aid tool (CPAT) on the quality of UFH 
      anticoagulation. DESIGN: Monocentric retrospective, quasi-experimental, 
      observational study. SETTING: Inpatient primary care centre between 1 January 
      2016 and 31 December 2019. PARTICIPANTS: >18 years-old treated with therapeutic 
      UFH for more than 24 hours. There were 819 and 1169 anticoagulation episodes 
      before and after intervention, respectively. INTERVENTION: In October 2017, we 
      implemented a pocket card with evidence-based recommendation for therapeutic UFH 
      initiation, monitoring and dosing adaptation. In October 2019, we implemented a 
      CPAT in a group subset. PRIMARY AND SECONDARY OUTCOMES: The primary outcome was 
      the time needed to reach a therapeutic anti-Xa before and after the 
      implementation of the pocket card. The secondary outcomes included a subgroup 
      analysis assessing the effect of the CPAT. Other secondary outcomes were the 
      anti-Xa status (infratherapeutic, therapeutic or supratherapeutic) at 7 and 24 
      hours of UFH treatment. RESULTS: We found a significant increase in the time to 
      reach therapeutic dosing with pocket card-guided recommendations implementation 
      (10.1 vs 14 hours, HR of 0.8, 95% CI: 0.70 to 0.93). However, the CPAT was 
      associated with a significant decrease in the time needed to reach the 
      therapeutic range (13.9 vs 7.1 hours, HR of 1.74, 95% CI: 1.17 to 2.60). 
      CONCLUSION: Although we observed an increase in time to reach therapeutic anti-Xa 
      with the pocket card, possibly due to a selection bias (use of activated partial 
      thromboplastin time for monitoring before the pocket card), the implementation of 
      CPAT significantly decreased the delay for effective therapy. Further studies are 
      needed to confirm these findings, and to determine the optimal initial dose of 
      UFH anticoagulation.
CI  - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Jimaja, Wedali E
AU  - Jimaja WE
AUID- ORCID: 0000-0002-9688-3164
AD  - Medecine, Division of general internal medicine, University Hospitals of Geneva, 
      Geneva, Switzerland wedali.jimaja@hcuge.ch.
FAU - Stirnemann, Jerome
AU  - Stirnemann J
AD  - Medecine, Division of general internal medicine, University Hospitals of Geneva, 
      Geneva, Switzerland.
AD  - Faculty of medecine, University of Geneva, Geneva, Switzerland.
FAU - Fontana, Pierre
AU  - Fontana P
AD  - Faculty of medecine, University of Geneva, Geneva, Switzerland.
AD  - Medicine, Division of angiology and hemostasis, University Hospitals of Geneva, 
      Geneva, Switzerland.
FAU - Blondon, Katherine S
AU  - Blondon KS
AUID- ORCID: 0000-0002-9407-8516
AD  - Faculty of medecine, University of Geneva, Geneva, Switzerland.
AD  - Medical directorate, University Hospitals of Geneva, Geneva, Switzerland.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20220315
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adolescent
MH  - *Anticoagulants/adverse effects
MH  - *Heparin/therapeutic use
MH  - Hospitals, University
MH  - Humans
MH  - Partial Thromboplastin Time
MH  - Prescriptions
MH  - Retrospective Studies
PMC - PMC8928257
OTO - NOTNLM
OT  - anticoagulation
OT  - protocols & guidelines
OT  - quality in health care
COIS- Competing interests: None declared.
EDAT- 2022/03/17 06:00
MHDA- 2022/04/06 06:00
PMCR- 2022/03/15
CRDT- 2022/03/16 05:55
PHST- 2022/03/16 05:55 [entrez]
PHST- 2022/03/17 06:00 [pubmed]
PHST- 2022/04/06 06:00 [medline]
PHST- 2022/03/15 00:00 [pmc-release]
AID - bmjopen-2021-056912 [pii]
AID - 10.1136/bmjopen-2021-056912 [doi]
PST - epublish
SO  - BMJ Open. 2022 Mar 15;12(3):e056912. doi: 10.1136/bmjopen-2021-056912.