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Pharmacoepidemiology and Risk Management 2023; 15(2): 172-180

Published online September 30, 2023 https://doi.org/10.56142/perm.23.0017

Copyright © Korean Society for Pharmacoepidemiology and Risk Management.

Enhancing Safety of Heparin Administration: An Analysis of Prolonged aPTT and Bleeding in Patients Receiving Heparin

헤파린 투여 환자에서 aPTT 연장 및 출혈 발생에 대한 분석

Hayun Chung1*, Jeong Uk Baek1*, Kyung A Kim1, Hyein Kang1, Eun Jung Cho1, Yoon Sook Cho1, Ju-Yeun Lee1,2, A Jeong Kim1

정하윤1*, 백정욱1*, 김경아1, 강혜인1, 조은정1, 조윤숙1, 이주연1,2, 김아정1

1Department of Pharmacy, Seoul National University Hospital, Seoul, Korea
2College of Pharmacy, Seoul National University, Seoul, Korea

1서울대학교병원 약제부, 2서울대학교 약학대학

Correspondence to:A Jeong Kim
Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Tel: +82-2-2072-3157
Fax: +82-2-2072-3764
E-mail: anemone@snuh.org

*The first two authors contributed equally to this work.

Received: August 28, 2023; Revised: September 13, 2023; Accepted: September 14, 2023

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective: Heparin, a high-risk medication with narrow therapeutic range, poses a significant risk to patient safety due to fatal accidents resulting from administration errors. This study aimed to analyze the cases of bleeding accompanied by prolonged activated partial thromboplastin time (aPTT) in patients undergoing continuous intravenous heparin infusion. Methods: We retrospectively reviewed the medical records of 200 adult patients who received continuous intravenous heparin infusion at Seoul National University Hospital from August 1, 2018 to July 31, 2021, and exhibited a prolonged aPTT exceeding 150 seconds. Bleeding was classified into major or minor bleeding. We classified the reasons for aPTT prolongation into four main categories: ‘protocol-related factors’, ‘human errors’, ‘administration of heparin bolus due to medical procedure’, and ‘individual variability’. This categorization was established through a thorough analysis of individual cases, including structural assessments. Results: Among the 200 patients, 62 (31.0%) patients experienced bleeding, with 20 (32.3%) exhibiting major bleeding. Notably, 37 (59.7%) of bleeding patients were concurrently administered other antithrombotic agents. The analysis revealed that 32 (16.0%) cases of aPTT prolongation were attributed to ‘protocol-related factors’, 73 (36.5%) to ‘human error’, and 83 (41.5%) to ‘individual variability’. Conclusion: This study showed that 'human error' and ‘protocol-related factors’ collectively contributed to more than 50% of prolonged aPTT among heparin users. To ensure safer heparin administration, it is strongly recommended to focus on optimizing heparin protocols and implementing strategies to reduce human errors.

KeywordsUnfractionated heparin, Continuous intravenous infusion, Activated partial thromboplastin time, Bleeding

Korean Society for Pharmacoepidemiology and Risk Management

Vol.16 No.2
September, 2024

eISSN 2982-5954

Frequency: Bimonthly

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