Analysis Of Heparin Monitoring

1981 ◽  
Author(s):  
J A Caprini ◽  
S J Rabadi ◽  
J P Vagher ◽  
J Mitchell
Keyword(s):  
Body Weight ◽  
Continuous Infusion ◽  
Clinical Symptoms ◽  
Heparin Therapy ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Daily Dose ◽  
Group 2 ◽  
Heparin Monitoring ◽  
Dose Change

Forty-six thrombosis patients were treated for a total of 437 days with continuous pump infusion heparin therapy. A bolus injection (50 units heparin/kg body weight) was followed by continuous infusion (14.2 units/kg/hour). The patients were randomized into 3 groups, daily coagulation profiles performed, and heparin dose adjusted by the following criteria: 1. no daily dose change unless indicated by clinical symptoms; 2. daily dose adjusted to yield an APTT 1.5 to 2X control; 3. daily dose adjusted to yield a negative TEG index.Group 2 received the most heparin, had the highest body weight, and greater incidence of minor bleeding ( + hemo- test urine and/or stool)(5 point drop in hematocrit).APTT values over 100 sec were seen in 44.4% of patients without bleeding and 52.5% with bleeding complications. Unmeasurable TEG graphs (SLT) were seen in 14.8% of patients without bleeding and 57.9% with bleeding. However, the combination of APTT over 100 sec and SLT were associated with 87.5% incidence of bleeding.The safety of continuous infusion heparin therapy is seen by the 2.2% incidence of major recurrent thrombosis and 2.2% major bleeding with or without laboratory monitoring. The combination of APTT and TEG was predictive of bleeding in 87.5% of cases. The TEG graph can be used to detect activated samples eliminating inconsistent APTT results.

scholarly journals Standartization of Heparin Therapy in Nyocardial Infarction

1977 ◽  
Author(s):  
J. Zahavi ◽  
S. Smetana
Keyword(s):  
Continuous Infusion ◽  
Significant Negative Correlation ◽  
Heparin Therapy ◽  
Plasma Fibrinogen ◽  
Heparin Dose ◽  
Interindividual Variations ◽  
Time Control ◽  
Daily Dose ◽  
Heparin Activity ◽  
Plasma Heparin

Sixty patients with myocardial infarction were randomized for intravenous 10 days heparin therapy, 400 U/ kg/ 24 hrs. In 20 of them, sodium heparin was injected every 6 hours and in another 20, by a continuous infusion preceded by a bolus of 50 U/kg. The remaining 20 patients were used as controls. Blood was drawn pre and 1-4 hours post heparin injection and then twice daily for the following tests: heparin tolerance, activated partial thromboplastin time (APTT), heparin half life and level. During continuous drip, theurapeutic anticoagulation (TA), 1,5–2,5 time control APTT levels, was maintained most of the time with daily and interindividual variations. When heparin was injected intermittently (I), TA was achieved only in the first 3–4 hours. In addition, a significant negative correlation between plasma fibrinogen and APTT, as well as a positive one between APTT and plasma heparin level, were found. These results suggest that heparin dose should be individualized during continuous infusion and when it is injected I, frequency of injections should not exceed 4 hours and the daily dose must presumably be higher then 400 U/kg, Plasma fibrinogen seems to be an important factor influencing negatively the heparin activity and should be considered during anticoagulant therapy with heparin.

Incidence of Bleeding Complications in Patients on Intermittent IV Heparin Therapy

1975 ◽  
Vol 9 (10) ◽  
pp. 560-565
Author(s):  
Robert J. Ignoffo
Keyword(s):  
Heparin Therapy ◽  
University Hospital ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Intravenous Heparin ◽  
Bleeding Episodes ◽  
Deep Vein ◽  
High Degree ◽  
Apparent Association

The incidence of bleeding from heparin therapy in patients with diagnosed pulmonary embolism and deep vein thrombosis was evaluated in a university hospital. Major or minor bleeding episodes occurred in 32 percent of patients and of these 50 percent were major episodes requiring cessation of therapy and blood transfusion. Activated clotting times were not excessively prolonged during bleeding episodes nor was there any apparent association with the age or sex of the patient. It is felt that bleeding secondary to intermittent intravenous heparin therapy may be the result of the high degree of clotting inhibition from 15 minutes to 2 hours after injection. It is suggested that continuous intravenous infusion of heparin is as effective as intermittent heparin injections and yet appears to produce a lower incidence of both major and minor bleeding episodes.

Use of a Modified Dosing Weight for Heparin Therapy in a Morbidly Obese Patient

2005 ◽  
Vol 39 (4) ◽  
pp. 753-756 ◽  
Author(s):  
Sarah J Schwiesow ◽  
Andrea M Wessell ◽  
Terrence E Steyer
Keyword(s):  
Body Weight ◽  
Continuous Infusion ◽  
Obese Patient ◽  
Infusion Rate ◽  
Heparin Therapy ◽  
White Female ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Acute Thrombosis ◽  
Ideal Body

OBJECTIVE: To report a case of successful anticoagulation using a modified dosing weight (DW) for unfractionated heparin (UFH) therapy in a morbidly obese female. CASE SUMMARY: A 54-year-old morbidly obese (182.4 kg, 155 cm) white female presented to the emergency department with tachycardia, shortness of breath, and chest pain, and was diagnosed with a pulmonary embolism. Anticoagulation with UFH was initiated. A modified DW of 120 kg was obtained from the average of the actual body weight (ABW) and ideal body weight (~50 kg). We selected this modified DW to account for heparin's altered volume of distribution in an obese patient and avoid potentially supratherapeutic activated partial thromboplastin times (aPTTs) using ABW and subtherapeutic aPTTs using DW. Therapy was initiated with a bolus dose of 9600 units (80 units/kg x 120 kg) and continuous infusion rate of 2160 units/h (18 units/kg/h x 120 kg). This infusion rate was maintained throughout the course of heparin therapy and was successful in maintaining therapeutic aPTTs. DISCUSSION: Proper diagnosis and rapid initiation of therapy prevent mortality in patients with PE. Although weight-based heparin nomograms provide standardization through initial bolus and continuous infusion recommendations, many do not address dosing in morbidly obese patients. Several retrospective studies have evaluated actual, dosing, and ideal body weights for heparin therapy in obese patients; however, none has evaluated modified DW. In our patient, successful anticoagulation was objectively confirmed. CONCLUSIONS: Further investigation is necessary to determine the optimal DW for UFH in morbidly obese patients presenting with acute thrombosis.

Hemorrhagic Complications of Heparin Therapy in Elderly People

1979 ◽  
Author(s):  
A. Kher ◽  
M.P. Hervy ◽  
J.F. Henry ◽  
F. Forette ◽  
P. Berthaux
Keyword(s):  
Heparin Therapy ◽  
Bleeding Complications ◽  
Control Group ◽  
Minor Bleeding ◽  
Duration Of Treatment ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Relationship Of ◽  
The Relationship

The most important side effect of heparin therapy is bleeding. The reported incidence has varied widely and the relationship of bleeding to dose, route of administration, age, sex, underlying haemostatic defect and hypertension has been suggested. A review of one years experience with subcutaneous heparin in 113 elderly patients is presented in this paper. They are divided into three groups : Group I without laboratory control, Group II - dosage of heparin being controlled with recalcification plasma test, and Group III-heparin requirement controlled by thrombo-elastography. Group I - 24 women (average age 82.1 years) receiving 5000 I.U. every 8 or 12 hours, mean duration of treatment 24 days ± 13.3 : one fatal retroperitoneal haemorrhage. Group II - 35 females, 10 males (average age 81.3 years), mean daily dose of heparin 13.250 I.U.(TID), duration of treatment 30.3 ± 24 days, 10 patients sustained bleeding complications. Group III -38 females, 6 males (average age 81.6 years), average daily heparin requirement 12.250 I.U. (TID), mean duration of treatment 42.2±55.5, 4 patients developed minor bleeding.The relationship between age, sex, control of heparin dosage and existence of hypertension will be discussed in detail.

scholarly journals Population Pharmacokinetic Study of Cefazolin Dosage Adaptation in Bacteremia and Infective Endocarditis Based on a Nomogram

2019 ◽  
Vol 63 (10) ◽  
Author(s):  
Ronan Bellouard ◽  
Colin Deschanvres ◽  
Guillaume Deslandes ◽  
Éric Dailly ◽  
Nathalie Asseray ◽  
...  
Keyword(s):  
Body Weight ◽  
Infective Endocarditis ◽  
Continuous Infusion ◽  
Population Pharmacokinetics ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Plasma Concentrations ◽  
Population Pharmacokinetic ◽  
Daily Dose

ABSTRACT Optimal dosing of continuous-infusion cefazolin can be challenging in patients being treated for bacteremia or infective endocarditis. The aim of this work is to describe and analyze the pharmacokinetics of cefazolin in those patients using a population pharmacokinetics modeling approach and to establish a nomogram to determine the optimal daily dose. Population pharmacokinetics were modeled using the Pmetrics package for R. Plasma concentrations were collected retrospectively from patients treated with continuous-infusion cefazolin for bacteremia or infective endocarditis. The influence of multiple parameters, including renal function, total body weight, body mass index, body surface area (BSA), ideal weight, lean body weight, height, and age, was tested. The probabilities of target attainment for selected target concentrations (40, 60, and 80 mg/liter) were calculated. A dosing nomogram was then developed, using the absolute value of the glomerular filtration rate (aGFR), to determine the optimal daily dose required to achieve the target concentrations in at least 90% of patients. In total, 346 cefazolin plasma concentrations from 162 patients were collected. A one-compartment model best described the data set. The only covariate was aGFR, calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and the patient’s body surface area, for the rate of elimination. Using the nomogram, achieving a cefazolin concentration target of 40 mg/liter with a success rate of at least 90% and with an aGFR of 30, 60, 90, and 120 ml/min requires a daily dose of 2.6, 4.3, 6.1, and 8.0 g/day, respectively. These results confirm the interest of posology adaptation of cefazolin according to aGFR.

scholarly journals PROTECTIVE EFFECT OF SOYBEAN OIL ON MICE LUNG TISSUE INJURY AND ALVEOLAR HEMORRHAGE INDUCED BY BISPHENOL A

2021 ◽  
Vol 71 (4) ◽  
pp. 1336-40
Author(s):  
Sadia Shaukat ◽  
Hina Kundi ◽  
Qazi Waheed Ullah ◽  
Nazish Waheed ◽  
Farah Deeba ◽  
...  
Keyword(s):  
Body Weight ◽  
Bisphenol A ◽  
Soybean Oil ◽  
Lung Tissue ◽  
Tissue Injury ◽  
Alveolar Hemorrhage ◽  
Tissue Weight ◽  
Group 4 ◽  
Daily Dose ◽  
Group 2

Objective: To evaluate histomorphological effects of Soybean oil supplementation on lung tissue injury and alveolar hemorrhage induced by Bisphenol A (BPA). Study Design: Laboratory-based experimental study. Place and Duration of Study: Anatomy department, Army Medical College, Rawalpindi and National Institute of Health, Islamabad, from Nov 2015 to Nov 2016. Methodology: Forty (40) healthy BALB/c mice of 9-11 weeks of age, weighing between 30-37gm were housed in a controlled environment at National Institute of Health. Group 1 (10) was control group. Group 2 (10) was given a daily dose of 50 milligram/kilogram body weight of Bisphenol A and group 3 (10) was given a daily dose of 500 milligram of Soybean oil and group 4 (10) was concurrently given Bisphenol A and Soybean oil with daily doses of 50 milligram/kilogram body weight and 500 milligrams. After a period of 8 weeks, animals were dissected 24 hours after receiving the last dosage. Lung wet weight, animal weight and relative body tissue weight index (RTBWI) were calculated. Tissue processing & staining was done. Alveolar hemorrhage was histomorphologically and statistically analysed using SPSS-21. Results: On microscopic examination, alveolar hemorrhage (AH) was observed in 10 (100%) group 2 specimens with increase in RTBWI and whereas only 5 (50%) of group 4 specimens had alveolar hemorrhage with slight improvement in relative body tissue weight index (RTBWI). Conclusion: Bisphenol A (BPA) induced lung injury as evident by intraalveolar hemorrhage, blood vessel congestion and increased RTBWI ratio were ameliorated by concomitant administration of Soybean oil.

Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

1998 ◽  
Vol 79 (03) ◽  
pp. 517-519 ◽  
Author(s):  
Stephane Heymans ◽  
Raymond Verhaeghe ◽  
Luc Stockx ◽  
Désiré Collen
Keyword(s):  
Deep Vein Thrombosis ◽  
Continuous Infusion ◽  
High Speed ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Long Term Follow Up ◽  
Valve Function ◽  
Rotating Impeller ◽  
Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

Systemic Thrombin Generation and Activity Resistant to Low Molecular Weight Heparin Administered Prior to Streptokinase in Patients with Acute Myocardial Infarction

1997 ◽  
Vol 77 (01) ◽  
pp. 057-061 ◽  
Author(s):  
Dennis W T Nilsen ◽  
Lasse Gøransson ◽  
Alf-Inge Larsen ◽  
Øyvind Hetland ◽  
Peter Kierulf
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Molecular Weight ◽  
Body Weight ◽  
Low Molecular Weight Heparin ◽  
Troponin T ◽  
Bleeding Complications ◽  
Control Group ◽  
Low Molecular Weight ◽  
Creatine Kinase Mb

SummaryOne hundred patients were included in a randomized open trial to assess the systemic factor Xa (FXa) and thrombin inhibitory effect as well as the safety profile of low molecular weight heparin (LMWH) given subcutaneously in conjunction with streptokinase (SK) in patients with acute myocardial infarction (MI). The treatment was initiated prior to SK, followed by repeated injections every 12 h for 7 days, using a dose of 150 anti-Xa units per kg body weight. The control group received unfractionated heparin (UFH) 12,500 IU subcutaneously every 12 h for 7 days, initiated 4 h after start of SK infusion. All patients received acetylsalicylic acid (ASA) initiated prior to SK.Serial blood samples were collected prior to and during the first 24 h after initiation of SK infusion for determination of prothrombin fragment 1+2 (Fl+2), thrombin-antithrombin III (TAT) complexes, fibrinopeptide A (FPA) and cardiac enzymes. Bleeding complications and adverse events were carefully accounted for.Infarct characteristics, as judged by creatine kinase MB isoenzyme (CK-MB) and cardiac troponin T (cTnT), were similar in both groups of patients.A comparable transient increase in Fl+2, TAT and FPA was noted irrespective of heparin regimen. Increased anti-Xa activity in patients given LMWH prior to thrombolytic treatment had no impact on indices of systemic thrombin activation.The incidence of major bleedings was significantly higher in patients receiving LMWH as compared to patients receiving UFH. However, the occurrence of bleedings was modified after reduction of the initial LMWH dose to 100 anti-Xa units per kg body weight.In conclusion, systemic FXa- and thrombin activity following SK-infusion in patients with acute MI was uninfluenced by conjunctive LMWH treatment.

Heparin Assays and Bleeding Complications in Treatment of Deep Venous Thrombosis with Particular Reference to Retroperitoneal Bleeding

1985 ◽  
Vol 53 (02) ◽  
pp. 278-281 ◽  
Author(s):  
H Asbjørn Holm ◽  
Ulrich Abildgaard ◽  
Sigmund Kalvenes
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Major Bleeding ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Thrombin Time ◽  
Heparin Infusion ◽  
Retroperitoneal Bleeding ◽  
Heparin Activity ◽  
The Difference

SummaryBleeding complications occurred in 30 (11%) out of 280 patients who received continuous heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients (3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified plasma [CaTT]). The differences in median heparin activity between patients with minor bleeding and patients with no bleeding did not reach significance for any of the tests. In patients with major bleeding, the differences were significant with the CS (p = .011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003), APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days of heparin treatment, but there was a considerable overlap with patients without bleeding.

Defensive activity of Hesperidin against Ciprofloxacin induced hepatic injury in rabbits.

2019 ◽  
Vol 10 (03) ◽  
Author(s):  
Hawraa M. Murad ◽  
Tamadhur Hani Hussein ◽  
Audai Sulaiman Khudhair ◽  
Manal Muhi Murad ◽  
Jawad Kadhim Faris
Keyword(s):  
Body Weight ◽  
Bacterial Infections ◽  
Hepatoprotective Activity ◽  
The Body ◽  
Local Breed ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Defensive Activity ◽  
Antioxidant Effects

This study was conducted to find out hepatoprotective activity of hesperidin (HES) 100mg/kg body weight (b.w.) against ciprofloxacin (CPX) 100 mg/kg induced hepatotoxicity in local breed rabbits .CPX is a broad spectrum antibiotic used for treatment of many bacterial infections. Twenty four male rabbits were divided into four groups ,group1: control, (1 ml/kg Saline orally) group 2: CPX (100 mg/kg orally) for (14) consecutive days , group 3: HES (100 mg//kg) orally for (14) consecutive days group 4: CPX (100 mg/kg orally) plus HES (100 mg//kg orally ) for (14) consecutive days. All the rabbits were killed on the (15) day of the experiment, and then the blood, and livers samples were taken. CPX induced hepatotoxicity was proved by a significant (p less than 0.01) reduction in the body weight ,and a significant (p less than 0.01) increased serum aspartate transaminase (AST), alanine transaminase (ALT) , Malonaldehyde enzyme (MAD) and histopathological changes. Protective hepatic toxicity effect and oxidative damage caused by CPX significantly (p less than 0.01) increasing in body weight and significantly (p less than 0.01) decreasing AST , ALT, MAD and improving tissue morphology in HES (100 mg//kg) . These results assure that HES (100 mg//kg) antioxidant effects can protect CPX-induced hepatotoxicity in rabbits.

Sign in / Sign up

Export Citation Format

Share Document