What should be done if APTT levels exceed 90 during heparin therapy?

When APTT (Activated Partial Thromboplastin Time) levels exceed 90 seconds during heparin therapy, it indicates a significantly increased risk of bleeding due to excessive anticoagulation. In such cases, the appropriate response is to hold the heparin dose to mitigate this risk and prevent potential complications associated with bleeding.

Holding the heparin allows for the immediate reduction of its anticoagulant effect, providing an opportunity for APTT levels to decrease to a safer range before resuming therapy. Continuous monitoring of APTT is essential during this time to determine when it is appropriate to reinstitute heparin at a potentially lower dose.

Maintaining the current heparin dose or reducing it may not be sufficient in preventing adverse outcomes if the APTT is critically high. Switching to another anticoagulant without first addressing the excessive heparin could lead to further complications, as it does not directly resolve the immediate concern of the elevated APTT. Therefore, the prudent course of action is to hold heparin to ensure patient safety.