Physician Practices in the Treatment of Pulmonary Embolism and Deep Venous Thrombosis

Arthur P. Wheeler, Robert D.B. Jaquiss, John H. Newman

Research output: Contribution to journalArticle

113 Scopus citations

Abstract

To quantify physican practices in the care of patients with presumed pulmonary embolism or deep venous thrombosis, we analyzed heparin sodium orders, the intensity of anticoagulation, and complications in 65 patients with the diagnosis of deep venous thrombosis or pulmonary embolism. All patients were given heparin, for a mean (± SEM) period of 8.8 ± 0.4 days. A high percentage of patients (60%) did not have a single partial thromboplastin time (PTT) greater than 1.5 times control within the first 24 hours of heparin therapy. Not until day 8 were 90% of PTTs in therapeutic range. We Identified five common practices that led to delays in achieving a PTT greater than 1.5 times the laboratory control: (1) failure to start heparin therapy at the time of initial clinical suspicion, (2) choice of a heparin sodium bolus (mean, 5861 ± 365 U) and continuous infusion (1026 ± 148 U/h) insufficient to elevate the PTT to greater than 1.5 times control, (3) delay in obtaining the first PTT (mean, 11.7 ± 1 h after start of heparin therapy), (4) insufficient heparin dosing in response to a low PTT, and (5) excessive and prolonged reductions in heparin therapy in response to a PTT greater than three times control, leading to subtherapeutic levels in 56% of subsequent PTTs. We think that poor understanding of heparin kinetics, overcautious behavior of physicians, and high heparin requirements in this selected population account for the findings.

Original languageEnglish (US)
Pages (from-to)1321-1325
Number of pages5
JournalArchives of Internal Medicine
Volume148
Issue number6
DOIs
StatePublished - Jun 1988

ASJC Scopus subject areas

  • Internal Medicine

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