Branson H E, van Stralen D, Schottinger J, Peters W, Endo Y
J Clin Pathol. 1985 Apr;38(4):422-7. doi: 10.1136/jcp.38.4.422.
A limited pilot study has been made of a newly devised heparin reduction algorithm (HRA). This formulation is a derivative of the alternative surveillance plan known as the activated partial thromboplastin time after heparin removal (aPTT/HR) scheme. Unlike the traditional plan, the HRA is the first approach to provide information about the individual and collective pharmacological effects of heparin and coumarins when the drugs are administered simultaneously. In this feasibility study the HRA was used without incident in six patients every 24 h to calculate the trend of the evolving anticoagulant effect of coumarin. The computations provided by a laboratory based data management group permitted the clinician to titrate precisely the withdrawal of heparin in response to the daily fluctuations in coumarin effect. In this way, the activated partial thromboplastin time could always be maintained within the desired therapeutic interval. Three divergent patient experiences are presented to demonstrate the operational characteristics and responsiveness of the new HRA plan.
已对一种新设计的肝素减量算法（HRA）进行了一项小型试点研究。该公式是一种替代监测计划的衍生形式，即肝素清除后活化部分凝血活酶时间（aPTT/HR）方案。与传统方案不同，HRA是第一种在同时使用肝素和香豆素类药物时提供有关肝素和香豆素类药物个体及总体药理作用信息的方法。在这项可行性研究中，每24小时对6名患者无意外地使用HRA来计算香豆素抗凝效果的演变趋势。由基于实验室的数据管理团队提供的计算结果使临床医生能够根据香豆素效果的每日波动精确调整肝素的撤药剂量。通过这种方式，活化部分凝血活酶时间总能维持在所需的治疗区间内。现展示三个不同患者的经历，以说明新HRA方案的操作特点和反应性。
