Evaluation of a Standardized Electronic Argatroban Dosing Nomogram for Heparin-Induced Thrombocytopenia: A Retrospective Study.

BACKGROUND

Heparin-induced thrombocytopenia (HIT) is an immunologic, potentially fatal complication resulting from exposure to heparin, an anticoagulant. This complication may be treated with argatroban, a thrombin inhibitor. But dosing errors with argatroban predispose patients to further complications, including thrombosis and bleeding.

PURPOSE: The purpose of this study was to assess the safety and efficacy of a standardized electronic argatroban dosing nomogram and electronic clinical decision support (e-CDS) tools used to achieve therapeutic activated partial thromboplastin time (aPTT) values in patients with confirmed or suspected HIT.

METHODS

This pre- and postimplementation retrospective study was conducted in nine hospitals across a large health care system in the northeastern United States. The primary outcome of interest was the percentage of patients with two consecutive therapeutic aPTT values within the first 24 hours of therapy. Secondary outcomes included the percentage of patients with two consecutive therapeutic aPTT values within the first 48 hours of therapy, time to the second consecutive therapeutic aPTT value, bleeding events, and nurse nomogram compliance during the 48 hours after initiation of therapy. Data were compiled through retrospective chart review.

RESULTS

The pre- and postimplementation groups comprised 34 and 36 patients, respectively. The percentage of patients achieving two consecutive therapeutic aPTT values within 24 hours of argatroban initiation was comparable between the pre- and postimplementation groups, at 70.6% and 63.9%, respectively. Twelve patients in the preimplementation group (35.3%) experienced bleeding events, compared to five patients in the postimplementation group (13.9%), a significant difference (P = 0.04). Nurse nomogram compliance increased significantly from 44.1% in the preimplementation group to 75% in the postimplementation group (P = 0.01).

CONCLUSIONS

The implementation of a standardized electronic argatroban dosing nomogram and e-CDS tools did not impact time to reach therapeutic aPTT values but was associated with improved nurse nomogram compliance and a reduction in bleeding events.