Westaway Kerrie P, Cruickshank Mary
Coronary Care Unit and Step-Down Cardiac Ward, Wakefield Hospital, Adelaide SA.
Aust Crit Care. 2006 Feb;19(1):6-8, 10-4. doi: 10.1016/s1036-7314(06)80017-2.
This study assessed the current practices of heparin dosing and determined the extent of therapeutic activated partial thromboplastin times (aPTT) achieved, utilising a standard heparin nomogram in the coronary care unit and step-down cardiac ward of a health care facility in South Australia. The study also examined the effect of actual body weight (ABW), body mass index (BMI), smoking, concomitant intravenous glycerine trinitrate, age, gender and creatinine levels, individually, on the time taken to attain a therapeutic aPTT in acute coronary syndrome (ACS) patients receiving a heparin infusion. A retrospective correlational research design was utilised to include the collection of quantitative data from 66 men and women of all ages and background consecutively admitted into the coronary care unit and the step-down cardiac ward and receiving a continuous heparin infusion. The quantitative data included demographic details plus all information regarding treatment and results of heparin therapy from the patients' medical records. Descriptive analysis of the data revealed 32% of the participants attained a therapeutic level with the first aPTT taken and that, successively, 35% and 45% of the participants attained a therapeutic level with the second and third aPTT taken. The majority of participants were found to be outside of the therapeutic range at any one time during the study. A generalised linear model (log-binomial model) applied to the data revealed that increased ABW (p=0.002), creatinine levels (p=0.033) and, in particular, BMI (p=0.000) were significant risk factors that contributed to the failure of participants attaining a therapeutic aPTT level. Age (p=0.668), gender (p=0.623), smoking (p=0.993) and the use of concomitant intravenous glycerine trinitrate (p=0.897) did not have a significant effect on the time to reach a therapeutic aPTT. The results provide noteworthy information for the re-evaluation of the use of the standard heparin nomogram. A robust randomised clinical trial is required to further examine BMI as the best predictor for heparin requirements in ACS patients receiving a heparin infusion.
本研究评估了肝素剂量的当前使用情况，并利用南澳大利亚一家医疗机构冠心病监护病房和心脏康复病房的标准肝素剂量表，确定了达到治疗性活化部分凝血活酶时间（aPTT）的程度。该研究还分别考察了实际体重（ABW）、体重指数（BMI）、吸烟、静脉注射硝酸甘油、年龄、性别和肌酐水平对接受肝素输注的急性冠脉综合征（ACS）患者达到治疗性aPTT所需时间的影响。采用回顾性相关研究设计，连续纳入66名来自不同年龄和背景、入住冠心病监护病房和心脏康复病房并接受持续肝素输注的男性和女性，收集定量数据。定量数据包括人口统计学细节以及患者病历中所有关于治疗和肝素治疗结果的信息。数据的描述性分析显示，32%的参与者首次检测aPTT时达到了治疗水平，随后，分别有35%和45%的参与者在第二次和第三次检测aPTT时达到了治疗水平。研究发现，大多数参与者在研究期间的任何时候都不在治疗范围内。应用于该数据的广义线性模型（对数二项模型）显示，ABW增加（p=0.002）、肌酐水平升高（p=0.033），尤其是BMI（p=0.000）是导致参与者未能达到治疗性aPTT水平的显著风险因素。年龄（p=0.668）、性别（p=0.623）、吸烟（p=0.993）和静脉注射硝酸甘油的使用（p=0.897）对达到治疗性aPTT的时间没有显著影响。这些结果为重新评估标准肝素剂量表的使用提供了值得注意的信息。需要进行一项有力的随机临床试验，以进一步研究BMI作为接受肝素输注的ACS患者肝素需求量最佳预测指标的情况。
