Pharmacoepidemiol Risk Manage.  2023 Sep;15(2):172-180. 10.56142/perm.23.0017.

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

• Chung H
• Baek JU
• Kim KA
• Kang H
• Cho EJ
• Cho YS
• Lee JY
• Kim AJ

• KMID: 2551234
• DOI: http://doi.org/10.56142/perm.23.0017

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 ‘protocolrelated 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.

Keyword

Unfractionated heparin; Continuous intravenous infusion; Activated partial thromboplastin time; Bleeding