Heparin Heuristics Lite
© 2017- JHLConsultants
E-mail: pcumpston@JHLConsultants.com
This application is based on the experience gained when providing anaesthetic care to over 1,000 patients undergoing catheter ablation for atrial fibrillation, and resulted from an approved clinical trial. The result of tis trial has been published in the Journal of AtrialFibrillation and Electrophysiology (Cumpston, P., & Phillips, K. P. (2024). A Novel Method for Calculating Heparin Dosing to Rapidly Achieve Target Anticoagulation for Cardiac Procedures. Journal of Atrial Fibrillation, 17(2).)
Disclaimer: This application must only be used by health professionals in the course of providing care to patients undergoing procedures where anticoagulation is required by the use of intravenous heparin, and where it is desired to reverse the anticoagulation with protamine. The decision to use this advice must be made by the supervising doctor, and cannot be used to replace clinical judgement.
This application is based on the experience gained when providing anaesthetic care to over 1,000 patients undergoing catheter ablation for atrial fibrillation. It was developed during a clinical trial entitled "A Heuristic Approach to determine the optimal method of Heparin Dosing and Reversal in all Patients Undergoing Anaesthesia for Catheter Ablation for Atrial Fibrillation (CA-AF)", ANZCTR Trial Id: ACTRN12618001489280 (https://www.anzctr.org.au) and approved by the Ramsay Human Ethics Committee: Clinical trial number 18/38 9th October 2019.
It can be used to estimate the initial bolus of heparin needed to achieve a desired ACT, given height, weight, sex, ACT before heparin and desired ACT.
The ACT must then be measured ten minutes after the inital heparin bolus and the result entered into the application in order to calculate the patient's individual ACT:heparin dose-response relationship.
This timing is essential for accuracy of subsequent calculations and is critically important.
The application learns as each new patient is added. After the first ten patients, accuracy for the intial heprin dose to achieve the desired ACT moves toward the 86% mark. There will, of course, be outliers. The application allows for dose adjustments based on the measured ACT. Estimates of the protamine dose needed to reverse heparin in the context of catheter ablation cases has been shown to be 97% accurate.
This software is NOT intended by its manufacturer to:
(a) be used for the sole purpose of providing alerts to health professionals in relation to patient care; and
(b)
(i) replace the clinical judgement of a health professional; or
(ii) diagnose, screen for, prevent, alleviate, treat, or make a decision about the treatment of, a disease, condition, ailment or defect
As each patient has details added, the application moves toward the average for the initial heparin dose calculations, but always uses the individual patient response to heparin to estimate the appropriate change in heparin bolus to achieve the desired ACT.
While this application helps guide the administration, maintenance and reversal of heparin, it is important to note that a normal ACT does not necessarily mean that there is no residual heparin, and does not mean that there is not an excess of protamine after reversal of heparin.
It is up to the individual practitioner to use their best judgment when using this application. It is not intended to replace clinical judgement by experience operators. For example, a protamine: heparin ratio of 0.8 to 1 may be considered optimal by some practitioners, but others may prefer the traditional 1:1 ratio.
The heparin image is taken from Public Domain, https://commons.wikimedia.org/w/index.php?curid=1034324
Information and links to citations forming the basis for the theoretical development of this app can be found at: https://HeparinHeuristics.com
