[Adherence to and Issues on our Institutional Guidelines on Heparin Administration after Withdrawal of Warfarin before Elective Surgery].

Background: We established local guidelines of heparin bridging therapy. However, it is unknown how adherence to our guidelines was achieved and whether our guidelines improved adherence compared with other universal guidelines.

Methods: A retrospective chart review was con- ducted on compliance with 3 recommendations in the guidelines; these are initial unfractioned heparin dose, timing of unfractioned heparin administration, and two times measurements of activated partial thromboplas- tin time (APTT). We compared 3 recommendations in the guidelines with platelet monitoring which is not described in the guidelines. We also investigated bleed- ing and thromboembolic events during heparin bridg- ing therapy according to the guidelines.

Results: Initial unfractioned heparin dose, timing of unfractioned heparin administration, measurements of APTT, and platelet monitoring were concordant with the guidelines in 78.9%, 19.7%, 67.6%, and 46.5%, respectively. Bleeding events occurred in 3 cases, but no thromboembolic events occurred. Adherence to rec- ommendations for timing of unfractioned heparin administration was the lowest and significantly lower than platelet monitoring.

Conclusions: Our local guidelines were partially effective to improve adherence We have to alert phy- sicians to care bleeding complications during heparin bridging therapy in our hospital.