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ABSTRACT: To assess bleeding and activated partial thromboplastin time (APTT) in relation to body mass index (BMI) in patients prescribed weight-based dosing of intravenous unfractionated heparin (UFH) for cardiac indications without a maximum (dose-capped) initial bolus or capped initial infusion rate.
Consecutive patients admitted to an academic medical center from February 1, 2002, through November 31, 2003, who were treated with a UFH nomogram consisting of a 60-U/kg intravenous bolus plus an initial continuous intravenous infusion of 12 U/kg hourly and titrated to a goal APTT range corresponding to thromboplastin-adjusted target heparin levels of 0.3 to 0.7 U/mL by anti-Xa assay were evaluated for this retrospective cohort study. Patients were excluded if they concomitantly received a fibrinolytic, glycoprotein IIb/IIIa inhibitor, or any other antithrombotic agent (except warfarin). Study patients were divided into quartiles by BMI.
Of the 1054 patients included in the study, 807 (76.6%) had an initial bolus dose higher than 4000 U, and 477 (45.3%) had an initial infusion rate higher than 1000 U/h. Despite a significant difference among BMI quartiles in proportion of supratherapeutic first APTT values (P<.001), no statistically significant difference was found in bleeding frequency (P=.26) or frequency of first APTT within the goal range (P=.27). Logistic regression analyses revealed that BMI was not a significant predictor of bleeding or first APTT within the goal range.
We did not find any difference in the proportion of first APTT values in the goal range or an increased risk of bleeding in obese patients treated with UFH without a capped initial dose. Our data demonstrate the safe use of weight-based UFH without a capped initial bolus dose or capped initial infusion rate in patients with medical cardiac conditions.
Mayo Clinic Proceedings 12/2009; 84(12):1073-8. · 5.70 Impact Factor
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ABSTRACT: To overcome errors in prescribing, calculating doses, and monitoring intravenous heparin, a computerized heparin nomogram system (HepCare) was developed to improve heparin safety using interactive cues between the prescriber, nurse, pharmacist, and the laboratory. The frequency of deviations decreased from 0.5 per patient before HepCare with the protocol to 0.006 per patient with HepCare and the protocol. The goal activated partial thromboplastin time results of the HepCare system (group I) were compared with patients who were not treated using the HepCare system (group II). There was a higher mean percentage of activated partial thromboplastin times within goal range in group I vs. II-44% vs. 27% (p<0.01). There were reminders of a drop in platelet count in 6% of patients, hemoglobin drop in 0.7%, and validation activated partial thromboplastin time values in 7% of patients by HepCare. HepCare-guided intravenous heparin resulted in significant improvements in safety, quality assurance, and targeted activated partial thromboplastin time values.
The American Heart Hospital Journal 01/2005; 3(2):75-81.
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ABSTRACT: Two ethnically different, community-based samples of hypertensive adults were evaluated to determine the prevalence of dyslipidemia and how often dyslipidemia is drug-treated and controlled by such treatment.
We studied 1286 non-Hispanic black hypertensive subjects from Jackson and 1070 non-Hispanic white hypertensive subjects from Rochester who participated in the Genetic Epidemiology Network of Arteriopathy study. Subjects were categorized according to presence of coronary heart disease and risk factors for coronary heart disease.
Prevalence of dyslipidemia was significantly greater among whites than blacks (women, 64.7% vs 49.5%; and men, 78.4% vs 56.7%; P<.001 for both) and among men than women (P</=.02 in each ethnic group). Among dyslipidemic subjects, treatment with lipid-regulating drugs was significantly more common among whites than blacks (women, 25.4% vs 16.4%, P =.001; and men, 32.6% vs 12.8%; P<.001), and among whites, treatment was significantly more common among men than women (P =.03). With drug treatment, control of dyslipidemia varied from 33.9% (white men) to 51.9% (black men), but the differences among ethnic-sex groups were not statistically significant.
Dyslipidemia is highly prevalent in hypertensive adults. Fewer than one third of these adults are drug-treated, and fewer than half of those treated achieve recommended goals. Our findings suggest that an alarming 9 of 10 dyslipidemic hypertensive adults have untreated or undertreated dyslipidemia.
Archives of Internal Medicine 06/2004; 164(12):1313-8. · 11.46 Impact Factor
