USE OF A STANDARDIZED HEPARIN NOMOGRAM TO ACHIEVE THERAPEUTIC ANTICOAGULATION AFTER THROMBOLYTIC THERAPY IN MYOCARDIAL-INFARCTION

Citation
Gc. Flaker et al., USE OF A STANDARDIZED HEPARIN NOMOGRAM TO ACHIEVE THERAPEUTIC ANTICOAGULATION AFTER THROMBOLYTIC THERAPY IN MYOCARDIAL-INFARCTION, Archives of internal medicine, 154(13), 1994, pp. 1492-1496
Citations number
12
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Medicine, General & Internal
ISSN journal
0003-9926
Volume
154
Issue
13
Year of publication
1994
Pages
1492 - 1496
Database
ISI
SICI code
0003-9926(1994)154:13<1492:UOASHN>2.0.ZU;2-M
Abstract
Background: The recently completed Thrombolysis in Myocardial Infarcti on (TIMI) 4 Study compared three thrombolytic treatment regimens for a cute myocardial infarction. The treatment arms included front-loaded r ecombinant tissue plasminogen activator (rtPA), anistreplase (APSAC), or both, in conjunction with an intravenous bolus of 5000 U of heparin , followed by 1000 U/h. To facilitate anticoagulation, a heparin nomog ram was developed to maintain the therapeutic activated partial thromb oplastin time at 1 1/2 to 2 times the control value. Methods: A poll r evealed that nine centers made use of the recommended heparin nomogram and six did not, adjusting the heparin dosage according to local prac tice. Anticoagulation parameters, major hemorrhagic events, and the fr equency of heparin interruption were compared between centers that use d and did not use the nomogram. Results: Subtherapeutic activated part ial thromboplastin time values were noted in 4%, 14%, 29%, 46%, 37%, a nd 34% of patients 8, 12, 24, 48, 72, and 96 hours, respectively, afte r heparin treatment was begun. Patients with subtherapeutic values at 24 hours were younger (mean+/-SD, 55.2+/-10.6 vs 59.6+/-10.6 years, P= .02) and weighed more (86.4+/-13.5 vs 78.9+/-15.7 kg, P=.007) than pat ients with therapeutic values. Centers that used the nomogram had sign ificantly fewer subtherapeutic values at 48 and 96 hours. In addition, heparin therapy was interrupted less frequently at centers that used the nomogram (38.1% vs 68.7%, P<.001). Major spontaneous hemorrhage, r einfarction, and reocclusion rates were low and were about the same in the two groups. Conclusions: The use of a heparin nomogram provided i mproved anticoagulation in patients treated with thrombolytic therapy for myocardial infarction. Weight- and age-adjusted heparin dosing may provide further improvement in anticoagulation with heparin therapy. Our findings support the need for frequent monitoring of the activated partial thromboplastin time and for a standardized approach to adjust ing the heparin dosage.