Prospective Observational Study to Check the Adequacy of Anticoagulation with Heparin as per Raschke\'s Protocol in Indian Population

INTRODUCTION: Thrombosis remains a significant contributor to morbidity and mortality globally, often requiring urgent anticoagulation therapy. Unfractionated heparin (UFH) is a cornerstone treatment due to its rapid onset, reversibility, and cost-effectiveness. However, UFH requires close monitoring using activated partial thromboplastin time (aPTT). Raschke's weight-based heparin dosing protocol, introduced in 1993, has been shown to improve therapeutic anticoagulation efficiency by adjusting heparin doses based on body weight and aPTT values. However, its efficacy has not been extensively studied in the Indian population, where differences in body composition, comorbidities, and healthcare infrastructure may affect outcomes. This study evaluates the adequacy of anticoagulation using Raschke's protocol in critically ill Indian ICU patients. OBJECTIVES: To evaluate the time required to achieve therapeutic anticoagulation, dose adjustments, and associated complications in ICU patients receiving heparin based on Raschke's protocol.(1,2) MATERIALS AND METHODS: A prospective observational study was conducted at a tertiary care hospital involving 70 critically ill patients requiring intravenous heparin. Heparin dosing followed Raschke's protocol with aPTT monitoring every six hours. The primary outcome was the time taken to achieve two consecutive therapeutic aPTT values (46-70 sec). Secondary outcomes included dose adjustments and complications. RESULTS: Therapeutic anticoagulation was achieved in 58% of patients within 48 hours. The mean time to first aPTT in the target range was 15±9.46 hours, while achieving two consecutive therapeutic values took 24.43±10.76 hours. Significant factors influencing anticoagulation included BMI, age, and SOFA scores. Thrombocytopenia (18.5%) and bleeding events (10%) were the most common complications.(3) DISCUSSIONS/CONCLUSIONS: Raschke's protocol demonstrates moderate effectiveness in achieving therapeutic anticoagulation in critically ill Indian patients. Its implementation requires individualized monitoring due to high interpatient variability and frequent dose adjustments. Future research should explore personalized dosing strategies, real-time monitoring methods, and larger multi-center trials.