Sample Essay on Standardization of Heparin Nomograms

Standardization of Heparin Nomograms

Introduction

The use of heparin for the treatment of acute venous thromboembolism has been in existence for a long time, and the results have been consistently encouraging. Reports have indicated that heparin is sometimes associated with the risk of hemorrhage, which makes the drug ineffective for use over extended periods (Agnelli et al., 2013). Additionally, studies have suggested some failures of heparin therapy due to sub-therapeutic doses, further complicating the use of the drug. However, when the drug is administered by continuous IV infusion method and the dosage is regulated with an appropriate clotting time, the risks associated with the drug are significantly reduced, and its efficiency is increased (John, Lisi, Greenfield & George, 2015). The challenge at hand is the determination of the correct and universal dosage to be administered without the risk of hemorrhage and failure due to sub-therapeutic doses (Agnelli et al., 2013). The standardization of heparin nomograms needs to take into account the method of admission and the difference in body weight before coming to a conclusion. Additionally, factors such as the influence of climate, location of the patients and the stage of the illness need to be put into context before the determination of the heparin nomograms.

Statement of the Problem

Due to the importance of heparin in the treatment of acute venous thromboembolism and the risks it poses due to under-dosing or overdosing, there is a need to establish a universal nomogram. Further, there exists confusion in the prescription of heparin to individuals who are affected by obesity, since their body weight might not reflect their age or medicinal requirement. Therefore, it is necessary to develop standardized heparin nomograms to cater for the needs of this group of individuals.

Cause of the Problem

The need for standardization of heparin nomograms for the treatment of various ailments is as a result of the disparities in administering the drug to different patients. The use of weight to prescribe heparin to patients has caused confusion due to the existence of people with obesity, given that their weight does not reflect their correct medical needs. Further, failures of heparin therapy due to sub-therapeutic doses present a situation that needs to be addressed, and this can be done by the development of a standardized heparin nomogram (John et al., 2015). Heparin dosage is also challenging due to the presence of other chronic diseases, such as diabetes, that may cause a shift in the efficiency of the medication (Sun et al., 2015). Additionally, the confusing issue associated with the use of heparin is a result of the risk of hemorrhage, which makes the drug ineffective for use over longer periods. In a nutshell, the problem is caused by the challenge of determining the correct dosage to be administered without the risk of hemorrhage and failure due to sub-therapeutic doses.

Possible Solutions

The standardization of heparin nomograms was designed with the intention of improving the treatment universally, by reducing the disparities witnessed before the invention of the nomogram. The nomogram is required to solve most of the problems and increase the efficiency of the drug by introducing a reliable globally acceptable system of infusion of the drug. Further, it is expected to address the concerns and bring solutions, by establishing standards for the use of heparin. One of the biggest challenges facing the use of heparin during the treatment of acute venous thromboembolism is the risk of hemorrhage, which makes the drug ineffective. This condition is more pronounced when the drug is used over an extended period. With this danger looming, it is rather challenging for medical practitioners to rely on the drug, despite its necessity. Studies have revealed that if heparin is administered to patients though continuous IV infusion, it helps reduce the dangers of hemorrhage (Agnelli et al., 2013). Continuous IV infusion process ensures that the drug is carefully monitored by medical practitioners to assess effects after short intervals to determine its effectiveness. Additionally, to ensure that the potential is reduced, the dose is regulated with predetermined clotting, which is aimed at ensuring that the risk of abnormal blood clot in the vessels is controlled (Kim et al., 2014). When these two precautions are taken into consideration, the efficiency and effectiveness of the drug is increased, making it possible to universally prescribe the drug.

The second challenge that faces the standardization of heparin nomograms is the dosage to be adopted, since there are disparities in the quantity and the interval of application in different parts around the world. The main confusion that exists concerns when heparin is used in conjunction with other drugs, or when it is prescribed to patients who are on other treatments. Additionally, uncertainty is witnessed in the monitoring of the recommendation after the prescription of the drug, which complicates health issues related to the use of this drug. Monitoring of the recommendation is a process whereby the physician studies the response of a patient to a drug and relates the observations with expected results. Comparing the results aids physicians in making decisions regarding the effectiveness of the dose or the need to adjust the dosage to achieve the expected outcome. Additionally, monitoring helps to determine if the interval of drug application is fit and relevant in achieving the required results or, it needs to be changed. Initially, the drug was administered using an IV bolus dose of 5,000 to 10,000 units of heparin, and the practice was nearly uniform and acceptable (John et al., 2015). This process was then followed by an infusion of 1,000 units per hour to make a complete cycle of medication.

On the other hand, some professionals have devised a new method, whereby the process is initiated with a loading dose of 50-100 units/kg of heparin, followed by a constant infusion of 15-25 units/kg/h (John et al., 2015). The disparities can be eliminated by adopting a universal process that involves determining initial heparin infusion rates by evaluating a patient’s blood volume. Since the drug acts directly on the blood, the determination of the blood volume is one of the best ways to estimate the dosage and interval of application of the drug. Further, the rate of clotting plays a vital role in the determination of the infusion of heparin, since there is a need to ensure that clotting in the vessel does not occur while a patient is under medication. This method is accurate and the results obtained are a true reflection of the effectiveness of the drug. The method, therefore, can eliminate the confusion that exists. The advantage of this method is that it can give a more precise and accurate model for the determination of dosage and schedules than methods initially used (Smythe et al., 2016). However, the method requires more medical procedures which are not the central concern of the patient, since the extra procedure may include the determination of blood volume.

There is a difficulty in the determination of the dosage, especially when a patient is obese; this is because their body weight does not directly reflect the medical requirement of obese individuals. Failure to adequately gauge the age of a patient because of obesity may lead to overdosing of the drug; therefore, cause additional health problems. The activated partial thromboplastin time (aPTT) values in morbidly and non-morbidly obese patients show differences (Kim et al., 2014). This creates the need to develop universally acceptable ways of administering the drug that will not compromise the quality of treatment. Development of a universal mode of administering medication is made possible by the studying of the factors that are required to achieve a supratherapeutic aPTT value. The solution to this problem can be achieved by ensuring that the Body Mass Index (BMI) and the age of individuals are considered during the identification of the risk of supratherapeutic aPTT (Kim et al., 2014). BMI is a conventional way of relating the body weight to the height of an individual, and it is vital in the determination of whether a patient is obese or has the correct weight for their height and age.

The use of BMI helps in determining the dosage that is effective, since the risk of underestimation and overestimation of heparin is reduced. The reduction in error during dosage leads to a more efficient attainment of results as the drug will work at optimum conditions (Lee et al., 2015). Further, the problem can be addressed by considering the use of alternative methods of administering the drugs which are likely to address the disparities. The methods include the use of dose cap for individuals with morbid obesity. This method can help in attaining reliable results, regardless of the body weight which may not be a reflection of an individual’s age. Additionally, the process of infusion of the drug must achieve the required results within the stipulated time which may reduce the risk of coagulation during the process of treatment (Kim et al., 2014). This method, however, has a disadvantage because it requires extra work, including determination of blood volume, before the commencement of the treatment process. Further, the BMI has to be determined for use in establishing the dosage and interval from the nomogram, making the process hectic and time consuming.

Christian worldview

Every human is equal and valuable before the eyes of the lord despite the shortcomings and the difference in the social and economic situation. This is the basis of the doctrines of christian teachings and belief. In the context of the standardization of heparin nomogram,  the  view of the development of a universal benchmark and reference point from where to treatment will be based is in line with the christian beliefs. The christian view of a universal world build on one mission and vision which is to promote the God’s desire is also promoted by the standardization of heparin nomogram. This is because it is Gods will for people to enjoy a healthy and fulfilling life. The healthy and fulfilling life will be realized by the implementation and the success of the standardization of the drug.

Recommendation

The standardization of heparin nomograms is a positive step towards the improvement of treatment of acute venous thromboembolism, since it has been effective for a long time. However, to ensure that the process of treatment is effective even when it comes to special groups, the following recommendations need to be put into consideration. Foremost, more research is required to determine the system of application of the drug on patient with chronic illness like diabetes and cancer, since such diseases are a great concern (Agnelli et al., 2013). Additionally, there is need for more research into how the drug should be infused when it comes to people with special needs, such as pregnant women, without risking the well-being of the unborn baby.

Conclusion

Acute venous thromboembolism is a disease that has been controlled by the use of heparin. However, major challenges that involve the use of the drug have been raised and they need to be addressed to ensure the drug remains relevant and poses minimal threats to patients. The use of heparin is sometimes associated with some risk of hemorrhage. Additionally, studies have suggested that failures of heparin therapy due to sub-therapeutic doses have been documented, further complicating the use of the drug. These challenges are responsible for the formation of a standardized heparin nomogram that can help in the determination of the correct and universal dosage to be administered. Moreover, the nomogram will reduce the risk of hemorrhage and failure due to sub-therapeutic doses. In the use of the nomogram, some other procedures are incorporated to reduce the impact of the effects and dangers that arise due to the use of the drug.

The procedures include the administration of heparin to patients using the continuous IV infusion method to reduce the dangers posed by hemorrhage. Further, more dangers can be combated by using blood volume to determine the dosage of the drug, since it ensures that patients who are obese are treated effectively. The standard heparin nomogram has been of help in the treatment of acute venous thromboembolism. However, challenges in the use of the nomogram still exist, and these include the use of the concept on pregnant women, obese people and those with chronic diseases. The possible dangers facing people with special needs call for more research and improvement of the nomogram to ensure it covers such people in a standard and universally accepted way.

References

Agnelli, G., Buller, H. R., Cohen, A., Curto, M., Gallus, A. S., Johnson, M., … & Weitz, J. I. (2013). Oral apixaban for the treatment of acute venous thromboembolism. New England Journal of Medicine, 369(9), 799-808. Retrieved from https://www.nejm.org /doi/full/ 10.1056/NEJMoa1302507

John, S. M., Lisi, D., Greenfield, N., & George, M. L. (2015). Antifactor Xa monitoring in patients on IV unfractionated heparin. US Pharm, 40(3), 18. Retrieved from https://www.uspharmacist.com/article/antifactor-xa-monitoring-in-patients-on-iv-unfractionated-heparin

Kim, J. S., Lee, H. J., Sung, J. D., Kim, H. J., Lee, S. Y., & Kim, J. S. (2014). Monitoring of unfractionated heparin using activated partial thromboplastin time: An assessment of the current nomogram and analysis according to age. Clinical and Applied Thrombosis/Hemostasis, 20(7), 723-728. Retrieved from http://journals.sagepub.com/doi/abs/10.1177/1076029613485153

Lee, A. Y., Kamphuisen, P. W., Meyer, G., Bauersachs, R., Janas, M. S., Jarner, M. F., & Khorana, A. A. (2015). Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: a randomized clinical trial. JAMA, 314(7), 677-686. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26284719

Smythe, M. A., Priziola, J., Dobesh, P. P., Wirth, D., Cuker, A., & Wittkowsky, A. K. (2016). Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism. Journal of Thrombosis and Thrombolysis, 41(1), 165-186. Retrieved from https://link.springer.com/article/10.1007/s11239-015- 1315-2

Sun, C., Bhat, R., Amirshahi, M., Dynin, M., Vaughns, J., Tefera, E., … & Goyal, M. (2015). 627: Appropriateness of rapid sequence intubation medication doses in obese vs. non-obese patients. Critical Care Medicine, 43(12), 158. Retrieved from https//journals.lww.com/ ccmjournal/toc/2015/1200