2026 Southeastern Residency Conference

Evaluation of Revisions to Pharmacist-Directed Heparin Infusion Protocol 
Caylen Wouters, Samantha Sims, Kristy Williams, Andrew Revels, Jordana Champion 
East Alabama Medical Center

ABSTRACT

Purpose 
At our institution, patients requiring heparin infusions are managed by the pharmacy staff based on activated partial thromboplastin time (aPTTs) levels. In July 2024, revisions to our institution’s heparin protocol changed the way pharmacists modified heparin drips based on aPTT levels. These changes included updating the nomogram for heparin infusion rate adjustments and reducing the number of required boluses per protocol. The purpose of this study is to assess the effects of these revisions on the institution’s current heparin protocol. 

Methods 
This study was a single-center, retrospective chart review evaluating the electronic health records (EHR) of adult patients admitted to our institution who received heparin for at least 48 hours according to the institution’s revised pharmacist-driven heparin protocol. The primary outcome was the frequency of achieving two consecutive therapeutic aPTTs within 48 hours of heparin infusion initiation. Secondary outcomes included: bleeding occurrences, number of aPTT levels drawn within 48 hours, total number aPTT levels drawn during infusion, number of patients who received initial heparin boluses, number of patients who received additional heparin boluses, number of times heparin drips held for elevated aPTTs, sub-, supra- and therapeutic aPTTs, time to achieving two consecutive therapeutic aPTTs, and duration of heparin drip. Patients were identified using admission dates between January-June 2024 for the pre-revision group and January-June 2025 for the post-revision group and then randomized and evaluated for inclusion. The statistical analysis was done using IBM SPSS Statistics version 30.0.0.0 (IBM Corp., 2024). The chi-square method was used for the nominal data within the primary and secondary outcomes, and the student t-test was used for the continuous data in the secondary outcomes. P-value < 0.05 was considered statistically significant.

Results
One hundred patients were included in the final analysis of this study with 50 patients in the pre-revision group and 50 patients in the post-revision group. Baseline characteristics included men and women averaging about 65 years old, mostly of White/European descent, and a BMI of about 29 kg/m2. For the primary outcome, there was no statistically significant difference in the achievement of two consecutive therapeutic aPTTs within 48 hours between the pre-revision group and the post-revision group (50% and 56% respectively, P= 0.689). Overall, the secondary outcomes were similar between groups and were not statistically significant. The one secondary outcome that demonstrated a statistically significant difference was the amount of additional heparin boluses administered during heparin treatment, with 48% in the pre-revision group and 14% in the post-revision group.

Conclusions
The updated pharmacist-driven heparin protocol demonstrated comparable efficacy to the prior protocol revealing no significant decrease in time to therapeutic range. The significant decrease in the number of supplemental boluses between groups indicated improvement in the initial dosing accuracy and enhanced dose adjustments within the new protocol. A reduction in heparin boluses may ultimately lead to a decrease in the risk of supratherapeutic anticoagulation, nurse workload, and interruptions in therapy; therefore, these reductions could help improve overall patient safety and operational efficiency.