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© 2009 American College of Chest Physicians


Chest. 2009;136(6):1708. doi:10.1378/chest.136.6.1708
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Notice: CHEST 2008; 133(6 suppl):67S–970S

On October 1, 2009, the US Food and Drug Administration revised the USP unit for unfractionated heparin. As a result, there likely will be an average decrease in the potency of 6% to 10% of one USP heparin unit. Although the authors of the Antithrombotic and Thrombolytic Therapy, 8th Ed: ACCP Guidelines (June 2008 supplement) do not find it necessary to revise the guidelines, they do want to emphasize the following:

  • For therapeutic use, physicians may or may not notice that larger doses of heparin are required to achieve “therapeutic” levels of anticoagulation. Clotting tests, such as the APTT, the ACT, or the TCT, should be used to guide heparin infusions.

  • In cases where fixed doses of heparin are used with clinical monitoring but without laboratory monitoring (such as extracorporeal circuits), increased heparin doses may or may not be required to prevent thrombotic complications and/or maintain circuit patency.

  • In cases where fixed doses of heparin are used without laboratory or clinical monitoring, physicians may or may not note reduced efficacy. This may particularly impact those clinicians who use large, weight-adjusted, fixed doses of heparin for the treatment of acute venous thromboembolism.


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