scholarly journals Diagnosis and Management of Pulmonary Embolism in Pregnancy

1996 ◽  
Vol 3 (3) ◽  
pp. 187-191 ◽  
Author(s):  
Sarah Broder ◽  
Peter Paré
Keyword(s):  
Pulmonary Embolism ◽  
Maternal Death ◽  
Partial Thromboplastin Time ◽  
Pulmonary Embolus ◽  
Significant Risk ◽  
Activated Partial Thromboplastin Time ◽  
Subcutaneous Route ◽  
Drug Of Choice ◽  
Intravenous Heparin ◽  
In Pregnancy

Pulmonary embolism in pregnancy is a significant and under-recognized problem. In British Columbia, where there are 46,000 pregnancies per year, it is estimated that there are approximately 160 pulmonary embolisms per year and one maternal death every two years secondary to pulmonary embolism. A complete assessment for suspected pulmonary embolus can be performed without putting the fetus at significant risk from radiation exposure. An algorithm is provided for the workup of pulmonary embolus during pregnancy. Heparin is the drug of choice for anticoagulating pregnant women, initially managing the situation with intravenous heparin and then switching to the subcutaneous route given in a bid or tid regimen, aiming to keep the activated partial thromboplastin time 1.5 to 2 times the control. The risks to both the fetus and the mother from anticoagulation during pregnancy are reviewed.

Clinical safety and cost of heparin titration using bedside activated clotting time

1993 ◽  
Vol 2 (1) ◽  
pp. 81-87 ◽  
Author(s):  
T Thomason ◽  
B Riegel ◽  
D Jessen ◽  
Smith SCJr ◽  
I Gocka ◽  
...  
Keyword(s):  
Partial Thromboplastin Time ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Clotting Time ◽  
Clinical Safety ◽  
Activated Clotting Time ◽  
Intravenous Heparin ◽  
Transluminal Coronary Angioplasty ◽  
Percutaneous Transluminal

OBJECTIVE: To evaluate the clinical safety of heparin titration and the procedural cost of anticoagulation measurement using bedside low-range activated clotting time. DESIGN: Quasi-experimental study using data gathered through retrospective record review. SETTING: Coronary care, medical intensive care and telemetry units of a community hospital. SUBJECTS: Sample of 102 patients undergoing elective percutaneous transluminal coronary angioplasty. INTERVENTION: Intravenous heparin therapy was titrated using low-range activated clotting time in 51 percutaneous transluminal coronary angioplasty patients. Data from this group were compared to a matched sample of 51 angioplasty patients whose intravenous heparin therapy was titrated using activated partial thromboplastin time. RESULTS: No differences in procedural, early or late complications were found between the groups. The cost of managing heparin therapy with low-range activated clotting time was less than with activated partial thromboplastin time. CONCLUSION: These results suggest that titrating heparin therapy based on bedside low-range activated clotting time for the angioplasty patients in this sample was as safe as with activated partial thromboplastin time. Use of bedside low-range activated clotting time saved money for the hospital.

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.

Evaluation of Point-of-care Activated Partial Thromboplastin Time Testing by Comparison to Laboratory-based Assay for Control of Intravenous Heparin

Angiology ◽  
2009 ◽  
Vol 60 (3) ◽  
pp. 358-361 ◽  
Author(s):  
Alexander D. Douglas ◽  
Jo Jefferis ◽  
Rishi Sharma ◽  
Rachel Parker ◽  
Ashok Handa ◽  
...  
Keyword(s):  
Partial Thromboplastin Time ◽  
Point Of Care ◽  
Activated Partial Thromboplastin Time ◽  
Testing System ◽  
Altman Analysis ◽  
Point Of Care Testing ◽  
Response System ◽  
Intravenous Heparin ◽  
Surgical Ward ◽  
Laboratory Assay

Introduction Patients on intravenous heparin require regular activated partial thromboplastin time monitoring. Laboratory-based activated partial thromboplastin time assays necessitate a delay between blood sampling and dose adjustment. Point-of-care testing could permit immediate dose adjustments, potentially enabling tighter control of anticoagulation. Aim To assess equivalence of activated partial thromboplastin time measured by conventional laboratory assay and by a novel proprietary point-of-care testing system (Hemochron Response, ITC, Thoratec Corporation, Edison, NJ) among surgical ward patients on intravenous heparin. Methods A total of 39 blood samples from patients on intravenous heparin were tested with both laboratory and point-of-care assays. Assay equivalence was assessed by Bland-Altman analysis. Results. Point-of-care measurements exceeded laboratory activated partial thromboplastin time by a mean of 15 seconds (standard deviation 19). In 19 cases (49%), the point-of-care measurement would have resulted in different heparin dosing from the laboratory activated partial thromboplastin time. Conclusions The Hemochron Response system is not sufficiently accurate for routine ward use compared with laboratory activated partial thromboplastin time assays.

scholarly journals Design and Implementation of an Anti–Factor Xa Heparin Monitoring Protocol

2020 ◽  
Vol 31 (2) ◽  
pp. 129-137
Author(s):  
Tanya Williams-Norwood ◽  
Megan Caswell ◽  
Barbara Milner ◽  
Joseph C. Vescera ◽  
Kelly Prymicz ◽  
...  
Keyword(s):  
Unfractionated Heparin ◽  
Partial Thromboplastin Time ◽  
Factor Xa ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Monitoring Protocol ◽  
Protocol Conversion ◽  
Therapeutic Anticoagulation ◽  
Intravenous Heparin ◽  
Heparin Dosage

Background: The VA Northeast Ohio Healthcare System introduced a new nurse-driven anti–factor Xa (anti-Xa) protocol for monitoring unfractionated heparin to replace the previous activated partial thromboplastin time protocol. Objective: To design, implement, and evaluate the efficacy of the anti-Xa monitoring protocol. Methods: An interdisciplinary team of providers collaborated to develop and implement a nurse-driven, facility-wide anti–factor Xa protocol for monitoring unfractionated heparin therapy. The effectiveness of this protocol was evaluated by retrospective analysis. Results: We reviewed 100 medical records for compliance with the new anti-Xa monitoring protocol. We then evaluated 178 patients whose anticoagulation was monitored with the anti-Xa assay to determine the time to therapeutic range. We found that 80% of patients receiving the anti-Xa protocol achieved therapeutic anticoagulation within 24 hours, as compared with 54% of patients receiving the activated partial thromboplastin time protocol (P < .001). Protocol conversion also yielded a decrease in blood draws, dose adjustments, and potential calculation errors. Conclusions: Monitoring intravenous heparin therapy with the anti-Xa assay rather than activated partial thromboplastin time resulted in a shorter time to therapeutic anticoagulation, longer maintenance of therapeutic levels, and fewer laboratory tests and heparin dosage changes. We believe the current practice of monitoring heparin treatment with activated partial thromboplastin time assays should be reexamined.

scholarly journals A patient with pleuritic chest pain and abnormal blood clotting tests

2014 ◽  
Vol 13 (4) ◽  
pp. 174-177
Author(s):  
Anastasia Vamvakidou ◽  
◽  
Dimitris Konstantinou ◽  
Sohail Salam ◽  
Mohsen Mahmoud ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Antiphospholipid Syndrome ◽  
Partial Thromboplastin Time ◽  
Blood Clotting ◽  
Activated Partial Thromboplastin Time ◽  
Pleuritic Chest Pain ◽  
Initial Management ◽  
Acute Setting

We present the case of a 58 year old man who developed pleuritic chest while an in-patient; investigations revealed pulmonary embolism, despite a significantly raised Activated Partial Thromboplastin Time (APTT), which was subsequently attributed to Antiphospholipid syndrome (APS). The diagnosis and initial management of APS in the acute setting is discussed.

Prolonged Activated Partial Thromboplastin Time In Pregnancy: A Brief Report

2004 ◽  
Vol 327 (3) ◽  
pp. 123-126 ◽  
Author(s):  
Linda A. Russo ◽  
Andrew Bernstein ◽  
Manish Sheth ◽  
Dilip V. Patel ◽  
Shahid Ahmed ◽  
...  
Keyword(s):  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
In Pregnancy

Lepirudin Use in a Neonate with Heparin-Induced Thrombocytopenia

2003 ◽  
Vol 37 (2) ◽  
pp. 229-233 ◽  
Author(s):  
Thuy N Nguyen ◽  
Peter Gal ◽  
J Laurence Ransom ◽  
Rita Carlos
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Partial Thromboplastin Time ◽  
Laboratory Tests ◽  
German Literature ◽  
Activated Partial Thromboplastin Time ◽  
Heparin Induced Thrombocytopenia ◽  
Drug Of Choice ◽  
Case Summary ◽  
Optimal Dosing

OBJECTIVE: To describe a case of heparin-induced thrombocytopenia (HIT) in a premature infant and the doses of danaparoid and lepirudin needed to achieve appropriate therapeutic endpoints. CASE SUMMARY: A 30-week gestational age infant was diagnosed with HIT with heparin antibodies. Danaparoid 2.0–2.4 units/kg/h achieved anti-Xa levels of 0.2–0.4 U/mL, but thrombocytopenia failed to resolve. Lepirudin was started in place of danaparoid. Lepirudin doses of 0.03–0.05 mg/kg/h achieved target activated partial thromboplastin time values of 1.5–2.0 times baseline. DISCUSSION: Dosing information for danaparoid in neonates is limited, and information for lepirudin appears only in German literature at this time. HIT is well documented in newborns, and lepirudin use in these situations is likely to increase. This report provides some guidance for optimal dosing. It also provides some guidance for HIT evaluation in preterm infants, in whom blood volume for laboratory tests is a major issue. CONCLUSIONS: HIT is an important and potentially fatal problem in neonates. Lepirudin may be the drug of choice, especially since danaparoid is now unavailable. Initial lepirudin dosing should not exceed 0.05 mg/kg/h.

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