Bleeding Risk Increases with Heparin Dose

Unfractionated heparin (UFH) is the cornerstone of therapy for patients with non–ST-segment-elevation acute coronary syndromes (NSTE ACS). Despite current American College of Cardiology/American Heart Association guidelines that recommend weight-based dosing (an initial bolus of 60–70 U/kg to a maximum of 5000 U and an infusion of 12–15 U/kg per hour to a maximum of 1000 U per hour), fixed-dosing regimens are still frequently used. The common practice of administering a bolus of 5000 U and an infusion of 1000 U/hour (the maximum recommended dose) results in considerable overdose for patients who weigh less than 60 kg. Using data from the CRUSADE Quality Improvement Initiative, researchers recorded dosing regimens used in clinical practice, …