Good afternoon Medlibbers,

I received a tough question from one of our hospital's physicians yesterday.  I've hit a wall and decided to send the question out to the collective Medlib knowledge base.

This is how the physician phrased the question:

We are having concerns raised as far as denials of payment by insurers for heparin infusions on inhouse patients.
I'd like a literature review of appropriate use criteria for heparin infusions in acute care vs use of low molecular weight heparin or novel oral anticoagulants. Typically, heparin drips are started in acute coronary syndrome, extensive clot burden with pulmonary emboli, to some extent with severe renal impairment, cancer patients and when rapid reversal is present. 
However there seems to be great divergence in the ordering of heparin drips so we are trying to establish best practice based on guidelines. This allows us traction then with the payers as well to 'push back' on denials.

It seems obvious to me that the physician is looking for practice guidelines on when to use unfractionated heparin drips in hospitalized patients as opposed to low-molecular-weight heparins or novel oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban).  I can't find a guideline.   I've located some systematic reviews, meta-analyses, and book chapters, but no guidelines.  Does anyone out there have any ideas?

Thanks!
Elissa

Elissa A. Kinzelman-Vesely, MA, MLIS
Medical Librarian, Library Services
 
Ascension Wisconsin 
3801 Spring Street
Racine, WI 53405
ascension.org/Wisconsin 
 
T: 262-687-8921 
V: 414-585-5085
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