Heparin therapy for thromboembolic disorders. A prospective evaluation of 134 cases monitored by the activated coagulation time

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Abstract
Patients [134] with venous thrombosis or pulmonary embolism, confirmed by radiological techniques, received continuous-pump heparin therapy while their responses were monitored by the activated coagulation time (ACT). The suggested protocol was as follows: give an i.v. bolus of about 50 U/kg; follow with 15-25 U/kg per h; modify infusion rate to maintain ACT of 150-190 s; after 2-3 days with ACT in target range, start oral warfarin sodium therapy; after 3-5 days of warfarin therapy, if prothrombin time is 2-2.5 times the control value, discontinue heparin administration. Patients [132] responded with no heparin failures. Dangerous bleeding occurred in 2 who received excessive amounts of heparin. Some patients, mostly with short ACT, responded slowly; some, many with long ACT, had minor bleeding. The protocol proved successful and safe when followed closely.

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