PRACTICE POINT

AUDIT POINT

• Objective test for diagnosis e.g. of venous thromboembolism

• Appropriate investigation results documented e.g. ultrasound scanning and/or venography for deep venous thrombosis; chest x-ray and ventilation/perfusion scanning for pulmonary embolism.

• Minimal delay in anticoagulation for venous thromboembolism.

• Time from provisional diagnosis to initiation of heparin

• Baseline investigations before full-dose heparin.

• Results of coagulation screen; blood count including platelet count; urea and electrolyte; liver function tests.

• Risk factors for full-dose anticoagulation.

• Age, past history; drug history recorded.

• Method of introduction of full-dose unfractionated heparin (bolus followed by intravenous infusion or subcutaneous injection).

• Initial intravenous heparin bolus prescribed; continuous intravenous heparin infusion or subcutaneous injection prescribed.

• Monitoring of unfractionated heparin anticoagulation (within 4-6 hours of introduction, then daily).

• First measurement of activated partial thromboplastin time (APTT) ratio four to six hours after introduction; APTT ratio documented on each day of heparin; APTT ratio within the therapeutic range for each day of heparin treatment