Clinical safety and cost of heparin titration using bedside activated clotting time.

Objective: To evaluate the clinical safety of heparin titration and the procedural cost of anticoagulation measurement using bedside low-range activated clotting time.

Design: Quasi-experimental study using data gathered through retrospective record review.

Setting: Coronary care, medical intensive care and telemetry units of a community hospital.

Subjects: Sample of 102 patients undergoing elective percutaneous transluminal coronary angioplasty.

Intervention: Intravenous heparin therapy was titrated using low-range activated clotting time in 51 percutaneous transluminal coronary angioplasty patients. Data from this group were compared to a matched sample of 51 angioplasty patients whose intravenous heparin therapy was titrated using activated partial thromboplastin time.

Results: No differences in procedural, early or late complications were found between the groups. The cost of managing heparin therapy with low-range activated clotting time was less than with activated partial thromboplastin time.

Conclusion: These results suggest that titrating heparin therapy based on bedside low-range activated clotting time for the angioplasty patients in this sample was as safe as with activated partial thromboplastin time. Use of bedside low-range activated clotting time saved money for the hospital.