Reilly B M, Raschke R, Srinivas S, Nieman T
University of Rochester School of Medicine and Dentistry, New York.
J Gen Intern Med. 1993 Oct;8(10):536-42. doi: 10.1007/BF02599634.
To characterize internists' dosing practices when administering and adjusting intravenous heparin regimens.
A survey administered by physician-investigators.
Two community teaching hospitals and one Veterans Affairs Medical Center.
Sixty-one attending physicians in internal medicine.
Physicians' choices of therapeutic activated partial thromboplastin time (APTT) range, initial heparin bolus, initial infusion dose, and dose/infusion adjustments when APTT levels are < 1.2 x control (< 35 seconds), 1.2-1.5 x control (35-45 seconds), 1.5-2.3 x control (46-70 seconds), 2.3-3.0 x control (71-90 seconds), and > 3.0 x control (> 90 seconds).
Physicians' dosing decisions and therapeutic ranges during heparin treatment varied widely. Responses to nontherapeutic APTT levels had especially high coefficients of variation (0.67-0.81). Two groups of physicians, together comprising a majority of all respondents, use mutually exclusive therapeutic ranges (mean 44-56 seconds and 60-83 seconds). These two groups differ significantly in several types of dosing decisions.
In the absence of generalizable standard guidelines for intravenous heparin therapy, internists' dosing practices vary widely. Because such practices may impede timely, effective anticoagulation, experimental studies comparing standardized dosing protocols are needed.
描述内科医生在给予和调整静脉注射肝素方案时的给药方法。
由内科医生研究者进行的一项调查。
两家社区教学医院和一家退伍军人事务医疗中心。
61名内科主治医师。
医生对治疗性活化部分凝血活酶时间（APTT）范围、初始肝素推注量、初始输注剂量以及当APTT水平<1.2倍对照值（<35秒）、1.2 - 1.5倍对照值（35 - 45秒）、1.5 - 2.3倍对照值（46 - 70秒）、2.3 - 3.0倍对照值（71 - 90秒）和>3.0倍对照值（>90秒）时的剂量/输注调整情况。
肝素治疗期间医生的给药决策和治疗范围差异很大。对非治疗性APTT水平的反应变异系数尤其高（0.67 - 0.81）。两组医生（占所有受访者的大多数）使用相互排斥的治疗范围（平均44 - 56秒和60 - 83秒）。这两组在几种给药决策类型上有显著差异。
在缺乏静脉注射肝素治疗的通用标准指南的情况下，内科医生的给药方法差异很大。由于这些方法可能会妨碍及时、有效的抗凝治疗，因此需要进行比较标准化给药方案的实验研究。
