Evaluation of 2 Weight-Based Protocols for Administration of Heparin
Bibliographic record
Abstract
Background: In 1996, a weight-based protocol for administration of heparin was implemented and assessed at the authors’ institution. Since then, several modifications have been made, including introduction of a lower-target protocol. These changes warranted re-evaluation of the standard and lower-target protocols.Objective: To determine and compare the efficacy and safety of the standard and lower-target protocols for heparin administration and to descriptively compare these findings with the original 1996 protocol.Methods: This 5-month retrospective, observational study involved 100 consecutive patients, 50 assigned to each of the 2 current protocols (standard and lower target), who were treated between September 2006 and January 2007. The primary outcomes were efficacy, represented by the time to achieve partial thromboplastin time (PTT) above the lower limit of the therapeutic range and within the therapeutic range, and safety, as indicated by the incidence of major bleeding and thromboembolic events over the entire course of heparin therapy.Results: There were no significant differences between the standard and lower-target protocols with respect to median time to achieve PTT above the lower limit of the therapeutic range (6.0 h versus 6.3 h, respectively; p = 0.24) or median time to achieve PTT within the therapeutic range (14.4 h versus 14.3 h, respectively; p = 0.93). Compared with the original 1996 protocol, these protocols appeared to have shorter times to achieve both of these outcomes. The rate of adverse events was infrequent, with fewer episodes of major bleeding (1%, for both current protocols combined) than in the 1996 study (10%).Conclusions: The 2 current weight-based protocols for administration of heparin appeared to have similar efficacy and safety and appeared to perform at least as well as the original 1996 protocol.RÉSUMÉ Contexte : En 1996, un protocole d’administration de l’héparine fondée sur le poids a été mis en oeuvre et évalué à l’établissement des auteurs. Depuis, plusieurs modifications ont été apportées, y compris l’introduction d’un protocole à valeurs cibles inférieures. Ces changements ont commandé la réévaluation des deux protocoles d’administration d’héparine.Objectif : Déterminer et comparer l’efficacité et l’innocuité des protocoles standard et à valeurs cibles inférieures pour l’administration d’héparine et présenter une comparaison descriptive des résultats obtenus à ceux du protocole original de 1996.Méthodes : Cette étude d’observation rétrospective de cinq mois a été menée chez 100 patients traités consécutivement entre septembre 2006 et janvier 2007, 50 étant assignés à chacun des deux protocoles (standard et valeurs cibles inférieures). Les paramètres d’évaluation primaires étaient l’efficacité, représentée par le temps écoulé pour obtenir un temps partiel de thromboplastine (PTT) au-dessus de la limite inférieure de l’écart thérapeutique et à l’intérieur de l’écart thérapeutique, et l’innocuité, selon l’incidence de saignements importants et d’événements thromboemboliques pendant toute la durée de l’héparinothérapie.Résultats : Les protocoles standard et à valeurs cibles ne différaient pas significativement quant au temps médian écoulé pour obtenir un PTT au-dessus de la limite inférieure de l’écart thérapeutique (respectivement 6,0 heures contre 6,3 heures, p = 0,24) ou quant au temps médian pour obtenir un PTT à l’intérieur de l’écart thérapeutique (respectivement 14,4 heures contre 14,3 heures, p = 0,93). Ces protocoles semblaient requérir moins de temps pour satisfaire à ces deux paramètres d’évaluation que dans l’étude de 1996. Les effets indésirables étaient peu fréquents, avec un taux de saignements importants (1 %, pour les deux protocoles actuels réunis) moindre que dans l’étude de 1996 (10 %).Conclusions : Les deux protocoles actuels d’administration d’héparine fondés sur le poids semblent être aussi sûrs et efficaces que le protocole original de 1996.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.068 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".