Continuous Subcutaneous Heparin Infusion During Pregnancy In A Patient With A Prosthetic Mitral Valve. Clinical And Laboratory Consideration

1981 ◽  
Author(s):  
Harry L Messmore ◽  
Jawed Fareed ◽  
Barbara Hixon ◽  
Judith Kniffin ◽  
Grace Squillaci
Keyword(s):  
Infusion Pump ◽  
Pregnant Patient ◽  
Activated Partial Thromboplastin Time ◽  
Poor Correlation ◽  
Intravenous Route ◽  
Subcutaneous Route ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Prosthetic Mitral Valve ◽  
Clinical Conditions

Administration of heparin for prolonged periods during pregnancy has usually been by the intravenous route when full anticoagulant dosages are required. Bolus subcutaneous injection of heparin has also been used, however this requires medical supervision and proper laboratory control. We have administered heparin (Elkins - Sinn) to a pregnant patient by the subcutaneous route utilizing an infusion pump (Auto-Syringe RModel AS3A) for 15 weeks, maintaining an activated partial thromboplastin time (APTT) of approximately 50 sec (N=22-35) using “ACTIN” (Dade) brand ellagic acid cephaloplastin reagent. The average heparin dose has been 26,000 units/24 hours during the 4th to 19th week of her pregnancy. In order to establish the presence of circulating heparin we also performed Xa and thrombin-based amidolytic assays for the absolute levels of heparin in patient’s plasma. A poor correlation was seen between the heparin levels and the APTT values. These data indicate that absolute levels of heparin may not be taken as an index of heparinization in certain clinical conditions. Lack of serious complications and ease of administration has prompted us to continue heparin by this route during the remainder of her pregnancy.

scholarly journals Decreased CRRT Filter Lifespan in COVID-19 ICU Patients

2021 ◽  
Vol 10 (9) ◽  
pp. 1873
Author(s):  
David Legouis ◽  
Maria F. Montalbano ◽  
Nils Siegenthaler ◽  
Camille Thieffry ◽  
Benjamin Assouline ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Historical Data ◽  
Activated Partial Thromboplastin Time ◽  
Control Group ◽  
Confounding Factors ◽  
Thromboembolic Events ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Icu Patients ◽  
Heparin Resistance

(1) Background: Increased thromboembolic events and an increased need for continuous renal replacement therapy (CRRT) have been frequently reported in COVID-19 patients. Our aim was to investigate CRRT filter lifespan in intensive care unit (ICU) COVID-19 patients. (2) Methods: We compared CRRT adjusted circuit lifespan in COVID-19 patients admitted for SARS-CoV-2 infection to a control group of patients admitted for septic shock of pulmonary origin other than COVID-19. Both groups underwent at least one session of CRRT for AKI. (3) Results: Twenty-six patients (13 in each group) were included. We analysed 117 CRRT circuits (80 in the COVID-19 group and 37 in the control group). The adjusted filter lifespan was shorter in the COVID-19 group (17 vs. 39 h, p < 0.001). This trend persisted after adjustment for confounding factors (−14 h, p = 0.037). Before CRRT circuit clotting, the COVID-19 group had a more procoagulant profile despite higher heparin infusion rates. Furthermore, we reported a decreased relation between activated partial thromboplastin time (aPTT) and cumulative heparin dose in COVID-19 patients when compared to historical data of 23,058 patients, suggesting a heparin resistance. (4) Conclusion: COVID-19 patients displayed a shorter CRRT filter lifespan that could be related to a procoagulant profile and heparin resistance.

scholarly journals Using anti-Xa level for adjusting intravenous unfractionated heparin infusion in peripartum thromboembolic disease

2018 ◽  
Vol 12 (3) ◽  
pp. 146-150
Author(s):  
Enrica Tse ◽  
Rshmi Khurana ◽  
Gwen Clarke ◽  
Winnie Sia
Keyword(s):  
Venous Thrombosis ◽  
Unfractionated Heparin ◽  
Partial Thromboplastin Time ◽  
Thromboembolic Disease ◽  
Activated Partial Thromboplastin Time ◽  
Term Pregnancy ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Thrombotic Risk ◽  
In Pregnancy

Background Intravenous unfractionated heparin infusion is often used to minimize the duration of time without anticoagulation around delivery in pregnant patients with high thrombotic risk. Activated partial thromboplastin time is commonly used to monitor and adjust heparin dose. However, using activated partial thromboplastin time is problematic in pregnancy because activated partial thromboplastin time response to unfractionated heparin is attenuated due to elevated Factor VIII levels and may lead to incorrect dosing. Case We report a case of deep venous thrombosis occurring in a term pregnancy managed by intravenous unfractionated heparin adjusted using anti-Xa level around the time of delivery. We modified the intravenous unfractionated heparin nomogram by using anti-Xa levels instead of activated partial thromboplastin time and observed lower dosing of unfractionated heparin than otherwise required to achieve and maintain target levels. Conclusion This report demonstrates the feasibility and effectiveness of using anti-Xa level to monitor and adjust intravenous unfractionated heparin infusion in pregnancy.

scholarly journals Use of Thromboelastogram in Venovenous Extracorporeal Membrane Oxygenation for a Patient with Pulmonary Hemorrhage due to Microscopic Polyangiitis

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Chak-Kwan Tong ◽  
Jun Jin ◽  
Qian Du
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Microscopic Polyangiitis ◽  
Pulmonary Hemorrhage ◽  
Activated Partial Thromboplastin Time ◽  
Clotting Time ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
Activated Clotting Time ◽  
Venovenous Extracorporeal Membrane Oxygenation

Systemic heparinisation is required for extracorporeal membrane oxygenation therapy, to prevent clotting of circuit and formation of thrombus in patient. Activated clotting time (ACT) or activated partial thromboplastin time (aPTT) has been the mainstay of monitoring of heparin dose. Thromboelastogram (TEG) is increasingly being used again in recent years with the advancement in technology. Its clinical usefulness in the monitoring of anticoagulation of ECMO therapy is demonstrated in the case presented. Our patient suffered from severe hemoptysis due to active microscopic polyangiitis and respiratory failure. Heparin infusion was given at the initiation of ECMO support without further aggravation of hemoptysis. Dose of heparin was adjusted successfully with the integration of the clotting profile and TEG results.

Anticoagulation by Constant Subcutaneous Heparin Infusion

1982 ◽  
Vol 47 (01) ◽  
pp. 001-002 ◽  
Author(s):  
Nenita Parrilla ◽  
Jack Ansell
Keyword(s):  
Clinical Trial ◽  
Impedance Plethysmography ◽  
High Dose ◽  
Intravenous Therapy ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Subcutaneous Infusion ◽  
Subcutaneous Heparin ◽  
Therapeutic Anticoagulation ◽  
Continuous Subcutaneous Infusion

SummaryA preliminary clinical trial was conducted to determine the feasibility of achieving and regulating therapeutic anticoagulation with heparin given by continuous subcutaneous infusion. Five patients with deep venous thrombosis confirmed by impedance plethysmography and/or venography were studied. All patients received an initial heparin dose of 5000 units by IV bolus. This was followed by a continuous subcutaneous heparin infusion at a dose of 15 to 25 units per kilogram per hour. Effective levels of anticoagulation were achieved in all five patients. Regulation and maintenance of therapeutic anticoagulation were no more difficult than with intravenous therapy. No major complications were encountered during therapy.Continuous subcutaneous infusion of heparin may have advantages over standard intravenous therapy or high dose intermittent subcutaneous therapy. However, more extensive clinical evaluation is warranted.

THE PRODUCTION OF IMMUNO-CONGLUTININ: II. THE INFLUENCE OF THE ROUTE OF INOCULATION ON THE IMMUNO-CONGLUTININ RESPONSE OF RABBITS TO HETEROSTIMULATION

1962 ◽  
Vol 8 (3) ◽  
pp. 307-313 ◽  
Author(s):  
D. G. Ingram
Keyword(s):  
Horse Serum ◽  
Intravenous Route ◽  
Subcutaneous Route

The inoculation of rabbits with kaolin coated with fresh horse serum results in the production of immuno-conglutinin. However, kaolin alone or kaolin coated with heat-inactivated horse serum fails to stimulate the production of immuno-conglutinin. These results are consistent with the hypothesis proposed by Coombs and Coombs (2) that immuno-conglutinin is an antibody against adsorbed complement.The data demonstrate that the intravenous route of inoculation is the most effective in stimulating the production of immuno-conglutinin in rabbits. The intramuscular and intraperitoneal routes are next in efficacy in that order. The subcutaneous route of injection was the least effective of the routes tested in stimulating an immuno-conglutinin (heterostimulation) response.

Comparison Between Subcutaneous and Intravenous DDAVP in Mild and Moderate Hemophilia A

1985 ◽  
Vol 54 (02) ◽  
pp. 387-389 ◽  
Author(s):  
L De Sio ◽  
G Mariani ◽  
M G Muzzucconi ◽  
A Chistolini ◽  
M C Tirindelli ◽  
...  
Keyword(s):  
Side Effects ◽  
Factor Viii ◽  
Hemophilia A ◽  
Subcutaneous Administration ◽  
Maximal Response ◽  
Intravenous Route ◽  
Time Interval ◽  
Subcutaneous Route ◽  
Coagulant Activity ◽  
Baseline Levels

SummarySixteen patients with mild and moderate hemophilia were given Desmopressin (DDAVP) subcutaneously in the absence of any actual bleeding. The response to the drug – in terms of factor VIII coagulant activity rise – became apparent 15 min after the injection, reaching the maximal response after one hour (x̄ 3.2 times the baseline levels; SD 1.21). This response was not different from that elicited using the intravenous route in 18 hemophiliacs of comparable severity after the same time interval. No local or general side-effects were recorded after the subcutaneous administration of DDAVP. We therefore conclude that the subcutaneous route adds further evidence to the reliability of this alternative treatment in mild factor VIII deficiencies, thus making home treatment with this vasopressin analogue possible.

Subcutaneous Administration of Amifostine During Fractionated Radiotherapy: A Randomized Phase II Study

2000 ◽  
Vol 18 (11) ◽  
pp. 2226-2233 ◽  
Author(s):  
Michael I. Koukourakis ◽  
George Kyrias ◽  
Stelios Kakolyris ◽  
Charalambos Kouroussis ◽  
Chryssi Frangiadaki ◽  
...  
Keyword(s):  
Phase Ii ◽  
Subcutaneous Administration ◽  
Intravenous Route ◽  
Pharmacokinetic Studies ◽  
Subcutaneous Route ◽  
Fractionated Radiotherapy ◽  
Flat Dose ◽  
Randomized Phase Ii ◽  
Perineal Skin ◽  
Grade 3

PURPOSE: Amifostine (WR-2721) is an impotant cytoprotective agent. Although intravenous administration is the standard route, pharmacokinetic studies have shown acceptable plasma levels of the active metabolite of amifostine (WR-1605) after subcutaneous administration. The subcutaneous route, due to its simplicity, presents multiple advantages over the intravenous route when amifostine is used during fractionated radiotherapy. PATIENTS AND METHODS: Sixty patients with thoracic, 40 with head and neck, and 40 with pelvic tumors who were undergoing radical radiotherapy were enrolled onto a randomized phase II trial to assess the feasibility, tolerance, and cytoprotective efficacy of amifostine administered subcutaneously. A flat dose of amifostine 500 mg, diluted in 2.5 mL of normal saline, was injected subcutaneously 20 minutes before each radiotherapy fraction. RESULTS: The subcutaneous amifostine regimen was well tolerated by 85% of patients. In approximately 5% of patients, amifostine therapy was interrupted due to cumulative asthenia, and in 10%, due to a fever/rash reaction. Hypotension was never noted, whereas nausea was frequent. A significant reduction of pharyngeal, esophageal, and rectal mucositis was noted in the amifostine arm (P < .04). The delays in radiotherapy because of grade 3 mucositis were significanly longer in the group of patients treated with radiotherapy alone (P < .04). Amifostine significantly reduced the incidence of acute perineal skin and bladder toxicity (P < .0006). CONCLUSION: Subcutaneous administration of amifostine is well tolerated, effectively reduces radiotherapy’s early toxicity, and prevents delays in radiotherapy. The subcutaneous route is much simpler and saves time compared with the intravenous route of administration and can be safely and effectively applied in the daily, busy radiotherapy practice.

scholarly journals Patients’ Perspectives on the Quality and Safety of Intravenous Infusions: A Qualitative Study

2019 ◽  
Vol 7 (3) ◽  
pp. 380-385 ◽  
Author(s):  
Carly Wheeler ◽  
Dominic Furniss ◽  
Galal H Galal-Edeen ◽  
Ann Blandford ◽  
Bryony Dean Franklin
Keyword(s):  
Health Care Professionals ◽  
Infusion Pump ◽  
General Medicine ◽  
Intravenous Route ◽  
Quality And Safety ◽  
Intravenous Infusions ◽  
Semistructured Interviews ◽  
Hospital Patients ◽  
Reduced Mobility

Background: The administration of medication or fluids via the intravenous route is a common intervention for many hospital inpatients. However, little research has explored the safety and quality of intravenous therapy from the patient’s perspective, despite the role of the patient in patient safety receiving increased attention in recent years. Objective: To explore patients’ perspectives on the perceived quality and safety of intravenous infusions and identify implications for practice. Method: Qualitative semistructured interviews were conducted with 35 hospital patients receiving intravenous infusions in critical care, oncology day care, general medicine, and general surgery areas within 4 National Health Service hospitals in England. Data were analyzed thematically. Results: Four underlying and interlinked themes were identified: knowledge about intravenous infusions, challenges associated with receiving intravenous infusions, the role of health-care professionals, and patients’ attitudes toward receiving infusions. Conclusions: Patients were generally satisfied with receiving infusions; however, factors that contributed to decreased feelings of quality and safety were identified, suggesting areas for intervention. Issues to do with infusion pump alarms, reduced mobility, cannulation, and personal preferences for information, if given more attention, may improve patients’ experiences of receiving intravenous infusions.

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