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A 10 mg warfarin initiation nomogram is safe and effective in outpatients starting oral anticoagulant therapy for venous thromboembolism.

https://arctichealth.org/en/permalink/ahliterature153058
Source
Thromb Res. 2009 Jul;124(3):275-80
Publication Type
Article
Date
Jul-2009
Author
Katherine Monkman
Alejandro Lazo-Langner
Michael J Kovacs
Author Affiliation
Department of Medicine, Division of Hematology, University of Western Ontario, London, Ontario, Canada.
Source
Thromb Res. 2009 Jul;124(3):275-80
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Administration, Oral
Adolescent
Adult
Aged
Aged, 80 and over
Ambulatory Care - methods
Anticoagulants - administration & dosage
Comorbidity
Dose-Response Relationship, Drug
Female
Hemorrhage - mortality
Humans
Incidence
Male
Middle Aged
Ontario - epidemiology
Retrospective Studies
Survival Rate
Treatment Outcome
Venous Thromboembolism - drug therapy - mortality
Warfarin - administration & dosage
Young Adult
Abstract
The optimal means of initiating warfarin therapy for acute venous thromboembolism in the outpatient setting remains controversial. We have previously demonstrated the efficacy of a 10 mg initiation nomogram in a randomized controlled trial; however, some clinicians remain reluctant to use this nomogram due to a fear of potential increased bleeding. To review the safety and efficacy of a 10 mg warfarin nomogram we conducted a retrospective cohort study of patients prospectively treated for venous thromboembolism according to a 10 mg nomogram in an outpatient thrombosis clinic. All patients received standard treatment with low molecular weight heparin for 5 to 7 days and warfarin for at least 3 months. Four-hundred and fourteen patients were included in the analysis, of whom 295 (71%) fully adhered to the nomogram. In the whole cohort, 8 patients (1.9%) experienced recurrent thrombosis, 4 (0.97%) suffered a major bleeding event, and 3 (0.72%) suffered a minor bleeding event. There were no deaths related to thrombosis or bleeding. Four patients (0.97%) died from unrelated causes. Twenty-two (5.3%) patients experienced an INR > or =5.0 in the first 8 days of therapy, and none of these patients experienced a bleeding event. Eighty-four percent of patients achieved a therapeutic INR by day 5. In outpatients, a 10 mg nomogram results in timely achievement of a therapeutic INR with an acceptable incidence of bleeding and recurrent thromboembolism.
PubMed ID
19155056 View in PubMed
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Acute iliofemoral venous thrombosis in patients with atresia of the inferior vena cava can be treated successfully with catheter-directed thrombolysis.

https://arctichealth.org/en/permalink/ahliterature135647
Source
J Vasc Interv Radiol. 2011 Jun;22(6):801-5
Publication Type
Article
Date
Jun-2011
Author
Rikke Broholm
Maja Jørgensen
Sven Just
Leif P Jensen
Niels Bækgaard
Author Affiliation
Department of Vascular Surgery, Rigshospitalet and Gentofte Hospital, University of Copenhagen, Denmark. rbroholm@dadlnet.dk
Source
J Vasc Interv Radiol. 2011 Jun;22(6):801-5
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Anticoagulants - administration & dosage
Catheterization, Peripheral
Denmark
Female
Femoral Vein - radiography
Fibrinolytic Agents - administration & dosage - adverse effects
Heparin - administration & dosage
Humans
Iliac Vein - radiography
Male
Middle Aged
Phlebography
Popliteal Vein
Retrospective Studies
Stockings, Compression
Thrombolytic Therapy - adverse effects
Time Factors
Tissue Plasminogen Activator - administration & dosage - adverse effects
Tomography, X-Ray Computed
Treatment Outcome
Vascular Malformations - complications - diagnosis
Vena Cava, Inferior - abnormalities - radiography - ultrasonography
Venous Thrombosis - complications - diagnosis - drug therapy
Warfarin - administration & dosage
Young Adult
Abstract
To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT).
From 2001 to 2009, 11 patients (median age, 32 y) with atresia of the IVC and acute iliofemoral DVT in 13 limbs were admitted for catheter-directed thrombolysis. Through a multiple-side hole catheter inserted in the popliteal vein, continuous pulse-spray infusion of tissue plasminogen activator and heparin was performed. Thrombolysis was terminated when all thrombus was resolved and venous outflow through the paravertebral collateral vessels was achieved. After thrombolysis, all patients received lifelong anticoagulation and compression stockings and were followed up at regular intervals.
Ultrasound or computed tomography revealed absence of the suprarenal segment of the IVC in two patients, and nine were diagnosed with absence of the infrarenal segment of the IVC. Median treatment time was 58 hours (range, 42-95 h). No deaths or serious complications occurred. Overall, complications were observed in four patients, one of whom required blood transfusion. Three patients were diagnosed with thrombophilia. Median follow-up was 37 months (range, 51 d to 96 mo). All patients had patent deep veins and one developed reflux in the popliteal fossa after 4 years. No thromboembolic recurrences were observed during follow-up.
Catheter-directed thrombolysis of patients with acute iliofemoral DVT and atresia of the IVC is a viable treatment option, as reasonable clinical outcomes can be obtained.
PubMed ID
21459610 View in PubMed
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[Acute non ST-elevation coronary syndrome in real practice of hospitals in Russia. Comparative data from RECORD 2 and RECORD registries].

https://arctichealth.org/en/permalink/ahliterature119478
Source
Kardiologiia. 2012;52(10):9-16
Publication Type
Article
Date
2012
Author
A D Erlikh
N A Gratsianskii
Source
Kardiologiia. 2012;52(10):9-16
Date
2012
Language
Russian
Publication Type
Article
Keywords
Acute Coronary Syndrome - diagnosis - epidemiology - therapy
Adult
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Coronary Angiography
Electrocardiography
Female
Follow-Up Studies
Heparin, Low-Molecular-Weight - administration & dosage
Hospital Mortality - trends
Hospitals - statistics & numerical data
Humans
Incidence
Injections, Subcutaneous
Male
Middle Aged
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors - administration & dosage
Registries
Retrospective Studies
Russia - epidemiology
Survival Rate - trends
Ticlopidine - administration & dosage - analogs & derivatives
Treatment Outcome
Young Adult
Abstract
to compare data on pre- and in hospital treatment of non ST-elevation (NSTE) acute coronary syndromes (ACS) in Russian ACS registers RECORD (recruitment from 11.2007 to 02.2008) and RECORD-2 (from 04/2009 to 04.2011).
Four of 7 hospitals participating in RECORD-2 were invasive (57.1% vs. 55.6% in RECORD). In RECORD-2 10-30 consecutive patients with NSTEACS were included monthly in each center; recruitment in RECORD was described elsewhere.
Mean age of patients was similar in two registries. Portion of women was significantly higher in RECORD-2 (42.9% vs. 26.0% in RECORD; 140) gave results close to those in all patients except mortality which was statistically similar but numerically higher in RECORD-2 (9.3 vs. 7.9% in RECORD; p=0.68).
Comparison of data of 2 limited NSTEACS registers conducted with interval of about 2 years showed only modest shift towards fulfillment of contemporary recommendations which was not associated with increase in rates of PCI and improvement of outcomes especially in high risk patients.
PubMed ID
23098345 View in PubMed
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Acute Traumatic Brain Injury: Mortality in the Elderly.

https://arctichealth.org/en/permalink/ahliterature266044
Source
World Neurosurg. 2015 Jun;83(6):996-1001
Publication Type
Article
Date
Jun-2015
Author
Erik Herou
Bertil Romner
Gregor Tomasevic
Source
World Neurosurg. 2015 Jun;83(6):996-1001
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Acute Disease
Age Factors
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Brain Injuries - complications - diagnosis - mortality - surgery - therapy
Craniotomy
Female
Glasgow Coma Scale
Head Injuries, Closed - complications - diagnosis - mortality - surgery - therapy
Hematoma, Subdural - etiology - surgery
Humans
Male
Prognosis
Retrospective Studies
Risk factors
Sweden - epidemiology
Treatment Outcome
Warfarin - administration & dosage
Abstract
Despite recent progress, prognosis for the elderly (defined as aged =70 years) afflicted by traumatic brain injury (TBI) is unfavorable and surgical intervention remains controversial. Research during the past decade on the mortality rates or prognostic factors for survival in the elderly is limited.
We analyzed 97 patients aged =70 years who were treated surgically for closed TBI at our neurosurgical unit between January 1, 2003 and December 31, 2012. In addition, we analyzed 22 patients aged =70 years who had sustained a closed TBI and on whom no neurosurgical intervention was performed. Outcome in both groups was measured as 30-, 90- and 180-day mortality.
Surgically treated patients: median age, 76 years' 30-day overall mortality rate, 36%. Higher mortality was seen with lower level of consciousness, high energy trauma, one pupil fixed and dilated, and more extensive intracranial pathology. Presence of warfarin, more advanced age, or degree of midline shift were not associated with worsened outcome. Patients not treated neurosurgically: median age. 81.5 years; 30-day overall mortality rate, 23%. Mortality for patients with Glasgow coma scale (GCS) 10-15 was 6%, GCS 6-9 67%, and GCS 3-5 100%.
Selected patients aged =70 years can benefit from surgical intervention for closed TBI. Level of consciousness, radiologic type of injury, mechanism of injury, and pupil abnormalities should be carefully evaluated. There also seems to exist a group of patients in whom surgical intervention offers little benefit, as mortality rate is low without surgical intervention.
PubMed ID
25731794 View in PubMed
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Added predictive ability of the CHA2DS2VASc risk score for stroke and death in patients with atrial fibrillation: the prospective Danish Diet, Cancer, and Health cohort study.

https://arctichealth.org/en/permalink/ahliterature124928
Source
Circ Cardiovasc Qual Outcomes. 2012 May;5(3):335-42
Publication Type
Article
Date
May-2012
Author
Torben Bjerregaard Larsen
Gregory Y H Lip
Flemming Skjøth
Karen Margrete Due
Kim Overvad
Lars Hvilsted Rasmussen
Author Affiliation
Department of Cardiology, Aalborg AF Study Group, Cardiovascular Research Centre, Aarhus University Hospital, Aalborg, Denmark. tobl@rn.dk
Source
Circ Cardiovasc Qual Outcomes. 2012 May;5(3):335-42
Date
May-2012
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Anticoagulants - administration & dosage
Atrial Fibrillation - drug therapy - epidemiology - mortality
Denmark - epidemiology
Diet - adverse effects
Female
Humans
Incidence
Life Style
Male
Middle Aged
Neoplasms - epidemiology
Predictive value of tests
Prognosis
Prospective Studies
ROC Curve
Registries
Risk assessment
Risk factors
Stroke - epidemiology - mortality - prevention & control
Time Factors
Abstract
The objective of this study was to evaluate the added predictive ability of the CHA(2)DS(2)VASc prediction rule for stroke and death in a nonanticoagulated population of patients with atrial fibrillation.
We included 1603 nonanticoagulated patients with incident atrial fibrillation from a Danish prospective cohort study of 57 053 middle-aged men and women. The Net Reclassification Improvement was calculated as a measure to estimate any overall improvement in reclassification with the CHA(2)DS(2)VASc sore as an alternative to the CHADS(2) score. After 1-year follow-up, crude incidence rates were 3.4 per 100 person-years for stroke and 13.6 for death. After a mean follow-up of 5.4 years (± 3.7 years), the crude incidence rates for stroke and death were 1.9 and 5.6, respectively. During the entire observation period, the c-statistics and negative predictive values were similar for both risk scores. The Net Reclassification Improvement analysis showed that 1 of 10 reclassified atrial fibrillation patients would have been upgraded correctly using the CHA(2)DS(2)VASc score.
Both the CHADS(2) as well as the CHA(2)DS(2)VASc risk score can exclude a large proportion of patients from having high risk of stroke or death. However, using the CHA(2)DS(2)VASc risk score, fewer patients will fulfill the criterion for low risk (and are truly low risk for thromboembolism). For every 10 extra patients transferred to the treatment group at 5 years, using the CHA(2)DS(2)VASc risk score, 1 patient would have had a stroke that might have been avoided with effective treatment.
PubMed ID
22534406 View in PubMed
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Adherence to warfarin treatment among patients with atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature265594
Source
Clin Res Cardiol. 2014 Dec;103(12):998-1005
Publication Type
Article
Date
Dec-2014
Author
Mika Skeppholm
Leif Friberg
Source
Clin Res Cardiol. 2014 Dec;103(12):998-1005
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Atrial Fibrillation - complications - therapy
Dose-Response Relationship, Drug
Drug Prescriptions - statistics & numerical data
Female
Follow-Up Studies
Humans
Incidence
Male
Medication Adherence
Middle Aged
Prognosis
Registries
Retrospective Studies
Stroke - epidemiology - etiology - prevention & control
Sweden - epidemiology
Time Factors
Warfarin - administration & dosage
Abstract
Treatment with warfarin greatly reduces the risk of stroke related to atrial fibrillation, but will not be effective unless patients adhere to treatment. Lack of fixed dosing makes it difficult to objectively estimate adherence to treatment from prescription data.
To evaluate two methods that assess adherence to warfarin from prescription data.
Retrospective study of Swedish health care registers.
Age- and sex-specific dose requirements were determined from approx. 1 million blood tests and dosing instructions. By applying these dosages to 163,785 warfarin-treated patients with atrial fibrillation, we calculated the quantity of warfarin that was needed to keep these patients on effective treatment during a mean follow-up of 3.9 years and compared that with the dispensed quantities. The ratio of available drug/time at risk constitutes a measure of adherence on group level. In addition, time intervals between refills were used to assess discontinuation.
Both methods showed that 45% of the patients did not have enough warfarin to last 80% of the time at risk. Between 16 and 21% of the patients discontinued within the first year, followed by 8-9% annually during the following years. Patients with high bleeding risk and patients with low embolic risk showed lower endurance.
Adherence to treatment with warfarin can be estimated on group level from prescription data and may be useful for comparison of adherence with warfarin and new oral anticoagulants. When applied to a large warfarin-treated cohort with atrial fibrillation, we found that adherence is low and that measures aiming for improvements are needed .
PubMed ID
25080281 View in PubMed
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Admission hyperglycemia predicts a worse outcome in stroke patients treated with intravenous thrombolysis.

https://arctichealth.org/en/permalink/ahliterature153259
Source
Diabetes Care. 2009 Apr;32(4):617-22
Publication Type
Article
Date
Apr-2009
Author
Alexandre Y Poppe
Sumit R Majumdar
Thomas Jeerakathil
William Ghali
Alastair M Buchan
Michael D Hill
Author Affiliation
University of Calgary, Calgary, Alberta, Canada. alexander.poppe@albertahealthservices.ca
Source
Diabetes Care. 2009 Apr;32(4):617-22
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - administration & dosage - therapeutic use
Canada
Cerebral Hemorrhage - complications - drug therapy - mortality
Cohort Studies
Diabetes Complications - drug therapy - mortality
Female
Humans
Hyperglycemia - complications
Infusions, Intravenous
Male
Middle Aged
Multicenter Studies as Topic
Multivariate Analysis
Prospective Studies
Regression Analysis
Risk factors
Stroke - complications - drug therapy - mortality
Tissue Plasminogen Activator - administration & dosage - therapeutic use
Treatment Outcome
Abstract
Admission hyperglycemia has been associated with worse outcomes in ischemic stroke. We hypothesized that hyperglycemia (glucose >8.0 mmol/l) in the hyperacute phase would be independently associated with increased mortality, symptomatic intracerebral hemorrhage (SICH), and poor functional status at 90 days in stroke patients treated with intravenous tissue plasminogen activator (IV-tPA).
Using data from the prospective, multicenter Canadian Alteplase for Stroke Effectiveness Study (CASES), the association between admission glucose >8.0 mmol/l and mortality, SICH, and poor functional status at 90 days (modified Rankin Scale >1) was examined. Similar analyses examining glucose as a continuous measure were conducted.
Of 1,098 patients, 296 (27%) had admission hyperglycemia, including 18% of those without diabetes and 70% of those with diabetes. After multivariable logistic regression, admission hyperglycemia was found to be independently associated with increased risk of death (adjusted risk ratio 1.5 [95% CI 1.2-1.9]), SICH (1.69 [0.95-3.00]), and a decreased probability of a favorable outcome at 90 days (0.7 [0.5-0.9]). An incremental risk of death and SICH and unfavorable 90-day outcomes was observed with increasing admission glucose. This observation held true for patients with and without diabetes.
In this cohort of IV-tPA-treated stroke patients, admission hyperglycemia was independently associated with increased risk of death, SICH, and poor functional status at 90 days. Treatment trials continue to be urgently needed to determine whether this is a modifiable risk factor for poor outcome.
Notes
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PubMed ID
19131465 View in PubMed
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Alcohol-related hospitalization is associated with increased risk of ischaemic stroke among low-risk patients with atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature296234
Source
Europace. 2018 01 01; 20(1):19-24
Publication Type
Journal Article
Date
01-01-2018
Author
Faris Al-Khalili
Lina Benson
Leif Friberg
Author Affiliation
Department of Clinical Sciences, Karolinska Institutet, Danderyds Hospital, s-182 88 Stockholm, Sweden.
Source
Europace. 2018 01 01; 20(1):19-24
Date
01-01-2018
Language
English
Publication Type
Journal Article
Keywords
Administration, Oral
Adolescent
Adult
Alcohol-Related Disorders - diagnosis - epidemiology - therapy
Anticoagulants - administration & dosage
Atrial Fibrillation - diagnosis - drug therapy - epidemiology
Brain Ischemia - diagnosis - epidemiology - prevention & control
Cerebral Hemorrhage - epidemiology
Female
Hospitalization
Humans
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Prognosis
Proportional Hazards Models
Registries
Retrospective Studies
Risk assessment
Risk factors
Stroke - diagnosis - epidemiology - prevention & control
Sweden - epidemiology
Time Factors
Young Adult
Abstract
Patients with atrial fibrillation (AF) under the age of 65 and CHA2DS2-VASc risk score of 0 in men or 1 in women are considered to be at low risk for ischaemic stroke, and therefore without benefit of oral anticoagulation therapy. The objective of this study is to assess the incidence and predictors of ischaemic stroke among low-risk patients with AF identified from a National Patient Register.
A retrospective study of 25 252 low-risk AF patients (age 18-64) out of total 345 123?AF patients identified from the Swedish Nationwide Patient Register for the period 1 January 2006 to 31 December 2012. During a median follow-up of 5.0 (interquartile range 2.9-6.8) years, ischaemic stroke occurred at an annual rate of 0.34 per 100 patient-years [95% confidence interval (CI) 0.31-0.38]. Significant predictors of stroke were age, hazard ratio (HR) 1.06 (CI 1.05-1.08) per incremental year, and previous alcohol-related hospitalization HR 2.01 (CI 1.45-2.79). Intracerebral bleeding events were rare and not statistically different HR 2.05 (CI 0.76-5.56) between patients with and without alcohol-related hospitalizations. Use of oral anticoagulants was associated with lower risk for ischaemic stroke, HR 0.78 (CI 0.63-0.97).
The presence of a previous hospitalization with an alcohol-related disease was associated with a small but significant increase in the risk of stroke among low-risk AF patients. More research about relation between alcohol use and ischaemic stroke in AF patients is warranted.
PubMed ID
28339885 View in PubMed
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[A management program for primary thrombocytopenia]

https://arctichealth.org/en/permalink/ahliterature64018
Source
Tidsskr Nor Laegeforen. 1999 Sep 30;119(23):3431-4
Publication Type
Article
Date
Sep-30-1999
Author
H. Knutsen
O. Bruserud
Author Affiliation
Medisinsk avdeling, Sentralsykehuset i Akershus, Nordbyhagen.
Source
Tidsskr Nor Laegeforen. 1999 Sep 30;119(23):3431-4
Date
Sep-30-1999
Language
Norwegian
Publication Type
Article
Keywords
Adult
Aged
Anticoagulants - administration & dosage
Aspirin - administration & dosage
English Abstract
Female
Guidelines
Humans
Hydroxyurea - administration & dosage
Interferon Type I, Recombinant - administration & dosage
Male
Middle Aged
Norway
Platelet Aggregation Inhibitors - administration & dosage
Pregnancy
Pregnancy Complications, Hematologic - diagnosis - drug therapy
Regional Medical Programs
Risk factors
Societies, Medical
Thrombocythemia, Hemorrhagic - diagnosis - drug therapy - therapy
Abstract
Essential thrombocythemia is a chronic myeloproliferative disease characterized by persistent thrombocytosis and an increased risk of thromboembolic complications. Most patients are asymptomatic at the time of diagnosis. In this article guidelines for diagnosis and treatment of this disorder are presented on behalf of the Norwegian Society of Hematology. On the basis of a literature search in international databases (Medline) and international medical journals, articles have been selected according to their clinical relevance. The risk of major thrombosis is higher in patients older than 60 years and highest among those with a previous occlusive event. In individual patients there is no clear relationship between platelet count and risk of thrombosis. Low-dose aspirin (75-100 mg/day) is recommended to all patients with platelet count
Notes
Comment In: Tidsskr Nor Laegeforen. 2000 Feb 10;120(4):512-310833946
PubMed ID
10553341 View in PubMed
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An Adjusted Calculation Model Allows for Reduced Protamine Doses without Increasing Blood Loss in Cardiac Surgery.

https://arctichealth.org/en/permalink/ahliterature284260
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Publication Type
Article
Date
Sep-2016
Author
Gunilla Kjellberg
Ulrik Sartipy
Jan van der Linden
Emelie Nissborg
Gabriella Lindvall
Source
Thorac Cardiovasc Surg. 2016 Sep;64(6):487-93
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - administration & dosage - adverse effects
Blood Coagulation - drug effects
Blood Coagulation Tests
Blood Loss, Surgical - prevention & control
Body Height
Body Weight
Cardiac Surgical Procedures - adverse effects
Cardiopulmonary Bypass - adverse effects
Computer simulation
Drug Dosage Calculations
Female
Heparin - administration & dosage - adverse effects
Heparin Antagonists - administration & dosage - adverse effects
Humans
Male
Middle Aged
Models, Biological
Postoperative Hemorrhage - etiology - prevention & control
Protamines - administration & dosage - adverse effects
Sweden
Time Factors
Treatment Outcome
Abstract
Background Heparin dosage for anticoagulation during cardiopulmonary bypass (CPB) is commonly calculated based on the patient's body weight. The protamine-heparin ratio used for heparin reversal varies widely among institutions (0.7-1.3?mg protamine/100 IU heparin). Excess protamine may impair coagulation. With an empirically developed algorithm, the HeProCalc program, heparin, and protamine doses are calculated during the procedure. The primary aim was to investigate whether HeProCalc-based dosage of heparin could reduce protamine use compared with traditional dosages. The secondary aim was to investigate whether HeProCalc-based dosage of protamine affected postoperative bleeding. Patients and Methods We consecutively randomized 40 patients into two groups. In the control group, traditional heparin and protamine doses, based on body weight alone, were given. In the treatment group, the HeProCalc program was used, which calculated the initial heparin bolus dose from weight, height, and baseline activated clotting time and the protamine dose at termination of CPB. Results We analyzed the results from 37 patients, after exclusion of three patients. Equal doses of heparin were given in both groups, whereas significantly lower mean doses of protamine were given in the treatment group versus control group (211?±?56 vs. 330?±?61?mg, p?
PubMed ID
26270199 View in PubMed
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242 records – page 1 of 25.