Targeting activated partial thromboplastin time of unfractionated heparin: the role of clinical pharmacist at the cardiac care unit

Background : Unfractionated heparin (UFH) requires precise monitoring, primarily via activated partial thromboplastin time (aPTT), to achieve therapeutic anticoagulation and minimize complications. Optimizing UFH therapy demands robust monitoring strategies and collaborative involvement of healthcare professionals, particularly pharmacists. Objective : This study aimed to evaluate aPTT levels in patients receiving UFH and determine the impact of clinical pharmacists on achieving target aPTT in a cardiac care unit (CCU). Patients and methods : A prospective observational study was conducted in the CCU of Baghdad Teaching Hospital from February 2023 to January 2024, enrolling patients prescribed UFH. Results : Of 307 patients, only 21% (n = 65) initially reached therapeutic aPTT levels. Notably, only 1 of 47 patients receiving subcutaneous UFH achieved target aPTT (P = 0.009). Clinical pharmacists performed 80 interventions, resulting in a statistically significant improvement in mean aPTT from 44.1 ± 24.8 to 46.7 ± 24 (P < 0.001). This increased the percentage of patients within the therapeutic range from 21% (n = 65) to 29% (n = 90). Conclusion : Clinical pharmacist interventions significantly improved aPTT targeting for UFH in the CCU, increasing therapeutic achievement rates despite initially suboptimal levels and highlighting their value in optimizing anticoagulation therapy.