Heparin..Part II..Heparin Resistance

Heparin resistance is defined in terms of the context: A) in treatment of VTE, if more than 35,000 u / 24 hour period is required to prolong the aPTT to the therapeutic range, or B) in cardiac bypass surgery, if after heparinization, there is at least one ACT greater than 400 s or if exogenous antithrombin is required.

In general, studies have sited heparin resistance to occur due to a multitude of factors in 22% of patients undergoing major surgery.
AT deficiency only accounts for one possible cause among many including increased clearance of heparin from the plasma, elevations of various heparin binding proteins (as mentioned above), elevations in FVIII and fibrinogen levels. Medications such as aprotinin and nitroglycerin have also been sited as causal of heparin resistance.
In patients previously exposed to heparin or requiring an IABP, resistance may arise. In the surgical population it is likely that when resistance to heparin occurs, it is due to decreased AT activity.

Lemmer JH et al found 85% of patients to have low AT activity, while another group noted the rate to be 77% of those who were heparin resistant. Both of these authors reported that AT concentrate was able to prolong the ACT to the target range in patients found to have below normal AT activity who did not initially achieve the target ACT.

Comments

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

Falling from Height...The Prognostic factors

Falls from Height is Knwon to cause major morbidities and mortalities. There are several prognostic factors for survival that have been identified: Height Age Type of surface Body part that touches the ground first Two other factors are important, but do not have a significant effect on mortality: Circumstances of the fall (suicide, accident, escape) Initial impact with an object before impacting the ground Height . Overall, about half of victims die at the scene, and a total of 70% die before they reach the hospital . The median height leading to death is about 49 feet, or about 4 to 5 storeys. 100% of victims die after falling 85 feet, or about 8 storeys. Age . Mortality increases with age due to pre-existing medical conditions and decreased physiologic reserve. Type of surface . The type of surface struck (i.e. grass, water, construction debris) can also have an effect on secondary injuries and survival. Mortality after striking a hard surface is nearly doubl...

The 12 decision making steps for post dural puncture headache treatment

Treatment decision-making algorithm for postdural puncture headache. 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment). 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10). 3. Virtually all patients will improve in time even without additional therapy. (dashed lines) 4. Symptoms worsen or fail to resolve within 5 days. 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP). 6. In patients with severe symptoms, EBP is strongly suggested. 7. The most common pharmacologic measure is caffeine prescription. 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP. 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg, dextran , saline). 10. A period of 24 h should lapse before repeating EBP. 11...

sedationstation

Search This Blog