肝素的合理使用。经验性给药与基于列线图的给药。

Appropriate use of heparin. Empiric vs nomogram-based dosing.

作者信息

Gunnarsson P S, Sawyer W T, Montague D, Williams M L, Dupuis R E, Caiola S M

机构信息

School of Pharmacy, University of North Carolina at Chapel Hill.

出版信息

Arch Intern Med. 1995 Mar 13;155(5):526-32.

PMID:7864708

Abstract

BACKGROUND

A study involving two groups of patients with cardiovascular disease was conducted to compare empiric (clinician-directed) heparin therapy with therapy based on a nomogram-determined dosage. The comparison was based on (1) the average weight-referenced infusion rate yielding a therapeutic activated partial thromboplastin time (APTT) and (2) the time required to reach a therapeutic APTT (55 to 95 seconds) after empiric or nomogram-based heparin therapy was initiated.

METHODS

Data were collected for patients admitted to the cardiology service at a university health science center in two phases: phase 1 (April 1 through June 30, 1992), involving 95 patients receiving heparin therapy, with 88 patients included in the data analysis, and phase 2 (March 11 through June 11, 1993), involving 156 patients receiving heparin therapy, with 45 patients receiving nomogram-guided therapy included in the data analysis.

RESULTS

In phase 1, 66 patients (75.0%) achieved a therapeutic APTT some time during their heparin therapy, with an average time to therapeutic APTT of 20.7 + 19.1 hours. Regression analysis demonstrated a statistically significant relationship between the heparin infusion rate at the time of the patient's first therapeutic APTT and the patient's total body weight (r2 = .3043). An initial infusion rate based on total body weight (13 U/kg per hour) was therefore used as the basis for the nomogram in phase 2. In phase 2, 41 patients (91.1%) achieved a therapeutic APTT at some time during their heparin therapy, with an average time to therapeutic APTT of 13.1 + 11.9 hours, statistically significantly shorter than that in phase 1. A greater proportion of patients in phase 2 compared with patients in phase 1 reached the therapeutic range within 12 hours (62.2% vs 34.1%) and within 24 hours (77.8% vs 54.5%).

CONCLUSIONS

Use of a weight-based nomogram to determine the initial and maintenance heparin infusion rates was associated with a higher percentage of patients admitted to the cardiology service reaching the targeted therapeutic APTT range at a time earlier in the course of therapy compared with empiric dosing.

摘要

背景

开展了一项针对两组心血管疾病患者的研究，以比较经验性（临床医生指导）肝素治疗与基于列线图确定剂量的治疗。该比较基于：（1）产生治疗性活化部分凝血活酶时间（APTT）的平均体重参考输注速率，以及（2）经验性或基于列线图的肝素治疗开始后达到治疗性APTT（55至95秒）所需的时间。

方法

分两个阶段收集了一所大学健康科学中心心脏病科收治患者的数据：第1阶段（1992年4月1日至6月30日），95例接受肝素治疗的患者，88例纳入数据分析；第2阶段（1993年3月11日至6月11日），156例接受肝素治疗的患者，45例接受列线图指导治疗的患者纳入数据分析。

结果

在第1阶段，66例患者（75.0%）在肝素治疗期间的某个时间达到了治疗性APTT，达到治疗性APTT的平均时间为20.7±19.1小时。回归分析显示，患者首次达到治疗性APTT时的肝素输注速率与患者总体重之间存在统计学显著关系（r2 = 0.3043）。因此，基于总体重的初始输注速率（13 U/kg每小时）被用作第2阶段列线图的基础。在第2阶段，41例患者（91.1%）在肝素治疗期间的某个时间达到了治疗性APTT，达到治疗性APTT的平均时间为13.1±11.9小时，在统计学上显著短于第1阶段。与第1阶段的患者相比，第2阶段有更大比例的患者在12小时内（62.2%对34.1%）和24小时内（77.8%对54.5%）达到治疗范围。