Therapeutic Initial Heparin Dosing for Patients With Clots or Certain Heart Conditions Admitted to the Hospital

NCT ID: NCT07250763

Last Updated: 2025-11-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE4

Total Enrollment

145 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-09-20

Study Completion Date

2027-05-31

Brief Summary

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The goal of this clinical trial study is to test whether a mathematical calculation, using the patient's gender, weight and kidney function, can better predict a patient's heparin goal dose than a flat number of units per patient weight can. Participants will have the first dose of heparin infusion calculated, after which if adjustments are needed, the Hospital's prebuilt table for results driven dosing for this purpose is used. The researchers will compare the time it takes for the participants to get to the desired goal using the patient's information for calculation versus patients in the past who received the medication using the flat rate. The hypothesis is that the patients with enhanced personal data, gender, weight and kidney function, included for the initial dose, will get to their goal lab value sooner and with less chance of delay or overshooting the goal. A quicker time to goal lab value is beneficial to patients in many ways, including earlier treatment of the clot or coronary issue that the patient is experiencing.

Detailed Description

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Heparin infusions are high-risk medications that must be titrated to effect within a narrow therapeutic anti-Xa range. Prolonging the time to reach the therapeutic range decreases the clinical effectiveness of the infusion and increases the potential for adverse drug events.

The intervention used in this study will be calculating the initial heparin infusion rates described below rather than dosing 18 units/kg/hr for the moderate-intensity protocol and 12 units/kg/hr with a dose cap of 1000 units/hr for the low-intensity protocol.

Moderate-Intensity Protocol (R2 = 0.48) Heparin infusion rate (unit/(kg\*hr))=(1004.8-163.5\*(1 if female)-4.8\*(age in years)+14.6\*(actual body weight in kg)-19.3\*(BMI in kg/m\^2))/(Actual body weight in kg)

Low-Intensity Protocol (R2 = 0.31) Heparin infusion rate (unit/(kg\*hr))=(615.5-70.1\*(1 if female)-1.7\*(age in years)+10.1\*(actual body weight in kg)-11.9\*(BMI in kg/m\^2))/(Actual body weight in kg)

All other components of heparin infusion management will be conducted per Inova Health System standard of care.

Conditions

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Pulmonary Embolism Deep Vein Thrombosis Atrial Fibrillation Acute Cardiac Syndrome Mechanical Heart Valve Recipients

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Retrospective chart review and data was used to develop a dosing equation that uses patient specific factors. Results of intervention group will be compared to the retrospective group.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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acute care patients prescribed heparin for treatment of DVT, PE or for conditions such as ACS, Afib

This arm will be participants whose initial dose will be using the patient specific calculator

Group Type EXPERIMENTAL

Initial Heparin Dose Modification

Intervention Type DRUG

A patient specific initial therapeutic dose calculator will be used to start the heparin drip. The aim is to start the patient on a dose that is or is close to the therapeutic dose - one that gets the patient to the goal outcome (lab value driven)

Interventions

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Initial Heparin Dose Modification

A patient specific initial therapeutic dose calculator will be used to start the heparin drip. The aim is to start the patient on a dose that is or is close to the therapeutic dose - one that gets the patient to the goal outcome (lab value driven)

Intervention Type DRUG

Other Intervention Names

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Use of a patient specific calculator to determine therapeutic dose at initiation of heparin

Eligibility Criteria

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Inclusion Criteria

* Age \> 18 years-old
* Diagnosis by the attending physician with one of the following conditions for which anticoagulation with heparin in an Food \& Drug Administration approved indication and considered the standard of care:
* Moderate-intensity anti-Xa protocol: new-onset deep vein thrombosis or pulmonary embolism, or mechanical heart valve
* Low-intensity anti-Xa protocol: atrial fibrillation, acute cardiac syndrome, embolic stroke
* Heparin infusion either has not started or has been initiated in the last 120 minutes

Exclusion Criteria

* Use of extracorporeal membrane oxygenation or ventricular assist devices such as Impella pumps
* Diagnosis of thrombophilia/hypercoagulable state
* Concurrent use of direct-acting oral anticoagulants or low molecular weight heparins
* Baseline anti-Xa \> 0.7
* Pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Inova Health Care Services

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Inova Alexandria Hospital

Alexandria, Virginia, United States

Site Status

Countries

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United States

References

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Fan J, John B, Tesdal E. Evaluation of heparin dosing based on adjusted body weight in obese patients. Am J Health Syst Pharm. 2016 Oct 1;73(19):1512-22. doi: 10.2146/ajhp150388.

Reference Type BACKGROUND
PMID: 27646813 (View on PubMed)

Schurr JW, Muske AM, Stevens CA, Culbreth SE, Sylvester KW, Connors JM. Derivation and Validation of Age- and Body Mass Index-Adjusted Weight-Based Unfractionated Heparin Dosing. Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029619833480. doi: 10.1177/1076029619833480.

Reference Type BACKGROUND
PMID: 30841720 (View on PubMed)

Smythe MA, Priziola J, Dobesh PP, Wirth D, Cuker A, Wittkowsky AK. Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism. J Thromb Thrombolysis. 2016 Jan;41(1):165-86. doi: 10.1007/s11239-015-1315-2.

Reference Type BACKGROUND
PMID: 26780745 (View on PubMed)

Granger CB, Hirsch J, Califf RM, Col J, White HD, Betriu A, Woodlief LH, Lee KL, Bovill EG, Simes RJ, Topol EJ. Activated partial thromboplastin time and outcome after thrombolytic therapy for acute myocardial infarction: results from the GUSTO-I trial. Circulation. 1996 Mar 1;93(5):870-8. doi: 10.1161/01.cir.93.5.870.

Reference Type BACKGROUND
PMID: 8598077 (View on PubMed)

Hirsh J, Raschke R, Warkentin TE, Dalen JE, Deykin D, Poller L. Heparin: mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest. 1995 Oct;108(4 Suppl):258S-275S. doi: 10.1378/chest.108.4_supplement.258s. No abstract available.

Reference Type BACKGROUND
PMID: 7555181 (View on PubMed)

Barletta JF, DeYoung JL, McAllen K, Baker R, Pendleton K. Limitations of a standardized weight-based nomogram for heparin dosing in patients with morbid obesity. Surg Obes Relat Dis. 2008 Nov-Dec;4(6):748-53. doi: 10.1016/j.soard.2008.03.005. Epub 2008 Jun 30.

Reference Type BACKGROUND
PMID: 18586569 (View on PubMed)

Riney JN, Hollands JM, Smith JR, Deal EN. Identifying optimal initial infusion rates for unfractionated heparin in morbidly obese patients. Ann Pharmacother. 2010 Jul-Aug;44(7-8):1141-51. doi: 10.1345/aph.1P088. Epub 2010 Jun 29.

Reference Type BACKGROUND
PMID: 20587743 (View on PubMed)

Shlensky JA, Thurber KM, O'Meara JG, Ou NN, Osborn JL, Dierkhising RA, Mara KC, Bierle DM, Daniels PR. Unfractionated heparin infusion for treatment of venous thromboembolism based on actual body weight without dose capping. Vasc Med. 2020 Feb;25(1):47-54. doi: 10.1177/1358863X19875813. Epub 2019 Oct 18.

Reference Type BACKGROUND
PMID: 31623539 (View on PubMed)

Zifko UA, Slomka PJ, Reid RH, Young GB, Remtulla H, Bolton CF. The cortical representation of somatosensory evoked potentials of the phrenic nerve. J Neurol Sci. 1996 Aug;139(2):197-202.

Reference Type BACKGROUND
PMID: 8856653 (View on PubMed)

Raschke RA, Gollihare B, Peirce JC. The effectiveness of implementing the weight-based heparin nomogram as a practice guideline. Arch Intern Med. 1996 Aug 12-26;156(15):1645-9.

Reference Type BACKGROUND
PMID: 8694662 (View on PubMed)

Other Identifiers

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U21-08-4517

Identifier Type: -

Identifier Source: org_study_id

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