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Heparin Therapy for Thromboembolic DisordersA Prospective Evaluation of 134 Cases Monitored by the Activated Coagulation Time
Paul G. Hattersley, MD;
J. Chris Mitsuoka, PharmD;
Jeffrey H. King, PharmD
JAMA. 1983;250(11):1413-1416.
Abstract
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One hundred thirty-four patients with venous thrombosis or pulmonary embolism, confirmed by radiological techniques, received continuous-pump heparin therapy while their responses were monitored by the activated coagulation time (ACT). The suggested protocol was as follows: (1) give an intravenous bolus of about 50 units/kg; (2) follow with 15 to 25 units/kg/hr; (3) modify infusion rate to maintain ACT of 150 to 190 s; (4) after two or three days with ACT in target range, start oral warfarin sodium therapy; (5) after three to five days of warfarin therapy, if prothrombin time is two to 2 1/2 times the control value, discontinue heparin administration. One hundred thirty-two patients responded, with no heparin failures. Dangerous bleeding occurred in two who received excessive amounts of heparin. Some patients, mostly with short ACTs, responded slowly; some, many with long ACTs, had minor bleeding. The protocol proved successful and safe when followed closely.
(JAMA 1983;250:1413-1416)
Author Affiliations
From the Departments of Internal Medicine (Hematology and Oncology) (Dr Hattersley), Pathology (Dr Hattersley), and Pharmacy (Drs Mitsuoka and King), University of California, Davis, School of Medicine, Sacramento.
Footnotes
Reprint requests to Department of Pharmacy, University of California, Davis, School of Medicine, 2315 Stockton Blvd, Sacramento, CA 95817 (Dr Mitsuoka).
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