Interet d'un nomogramme fonde sur le poids et gere par l'infirmiere pour adapter la posologie de l'heparine non fractionnee

OBJECTIVE: To assess efficiency of a nurse directed weight-based nomogram (NWN) for heparin dosage without training. STUDY DESIGN: Prospective, comparative, before/after intervention study. PATIENTS AND METHODS: In a university medical intensive care unit, 19 patients receiving unfractionned intravenous heparin, following standard medical prescriptions (SHT), were compared to 19 patients submitted to NWN (80 U kg(-1) bolus, starting infusion at 18 U kg(-1) h(-1) and secondary dosage adaptations following a specific nomogram). RESULTS: Dose of heparin bolus and starting dose infusion were significantly greater in NWN group than in the SHT group. The delay in achieving a predetermined therapeutic APTT level of at least 60 s was 6 (1-76) hours in the SHT group and 4 (3- 32) hours in the NWN group. The target APTT (60-85 s) was obtained after 13.5 (1-76) hours and 9.5 (3-32) hours in the two groups, respectively. Although reduction in delay seemed to favour anticoagulation dictated by the NWN protocol, the difference failed to reach statistical significance. Percentage of target APTT over total number of APTT values per patient was significantly higher in the NWN group (41 [0-87] vs. 31% [0-54]) in the SHT group. Strict observance of anticoagulation by using NWN tended to be better than that in SHT group. CONCLUSIONS: NWN protocol was easy to use without previous training. NWN was associated with the best anticoagulation state although its superiority was less evident than expected.