Heparin. 4.2 Heparin

Transcription

1 Heparin 4. Heparin 4.2 Heparin 5. aptt 5.2 aptt /

2 , 2, 3, Q (NQMI) , 5 Heparin (straight-chain anionic glycosaminoglycans) III (antithrombin III) (warfarin 8-2 ) heparin antithrombin III thrombin heparin antithrombin III antithrombin thrombin heparin-antithrombin III thrombin Xa ( ) heparin antithrombin III heparin 5 Heparin 2

3 3. Heparin 00 % IV SC L/hr/kg L/kg 0.5 to 0. ml/kg/min 3.2 heparin (Low Molecular Weight Heparin LMWH) 3.2. heaparin / LMWH Xa:IIa (daltons) (%) ( ) Ardeparin Normiflo, : Dalteparin Fragmin, : Enoxaparin Lovenox 4, : Tinzaparin Innohep, : Dalteparin/ Enoxaparin Dalteparin 2500 uints Enoxaparin 40 mg A max (units/ml) 0.22 ± ± 0.4 t max (hr) T /2 elimination 2.8 ± ± 0.47 CL/F (ml/min) ± ± 3.7 V (L) 7.74 ± ±.20 A max = maximum plasma activity 3

4 4 4. Heparin Heparin 5,000 U S.C q8h or q2h or adjusted low-dose heparin 5,000 U IV bolus followed by 32,000 U q24h by IV infusion or 35,000 to 40,000 U q24h S.C., adjusted to maintain aptt in the therapeutic range 5,000 U IV bolus followed by 32,000 U q24h IV ( ) infusion adjusted to maintain aptt in the therapeutic range 5,000 U IV bolus followed by 24,000 U q24h IV infusion adjusted to maintain aptt in the therapeutic range 4.2 Heparin LMWH Ardeparin 50 units/kg twice daily Dalteparin 2,500 IU S.C. daily 2,500 IU S.C. twice daily or 5,000 IU S.C. daily 20 IU/kg S.C. twice daily or 200 IU/kg S.C. daily Enoxaparin 40 mg S.C. daily 30 mg S.C. every 2 hr mg/kg S.C. every 2 hr or.5 mg/kg S.C. daily Tinzaparin 75 IU/kg S.C. once daily 4

5 , 5. aptt aptt aptt ( ) 5.2 aptt aptt 2. heparin aptt aptt aptt 3. Heparin ( ) aptt aptt (minutes) (units/hr) 50 5,000 units hr hr Next morning Next morning hr hr 4. heparin a ( ) aptt ( ) aptt (units/kg/hr) 35 (.2 mean normal) +4 Rebolus with 80 IU/kg (.2-.5 mean normal) +2 Rebolus with 80 IU/kg 4-70 ( mean normal) 0 0 b 7-90 ( mean normal) ( 3 mean normal) -3 Hold infusion hr a Initial dosing: loading dose is 80 IU/kg;maintenance infusion is 8 IU/kg/hr (aptt in hr) b During the first 24 hr, repeat apt every hr. Thereafter, monitor apt once every moring unless it is outside of the therapeutic range. 5

6 5.3. heparin unit/ml 2. heparin warfarin heaparin heparin Xa warfarin Xa Xa 3. (aptt PT/INR CBC) 4. heparin aptt heparin aptt 5. warfarin INR 2 INR heparin. heparin aptt Heparin. - heparin Xa ACT Xa >32 weeks 32 weeks ACT: Activated coagulation time Xa Xa Clotting time ACT ACT ACT

7 .2 -, 7 Nitroglycerin (IV) ( aspirin NSAID) Warfarin GP Iib/IIIa antagonists heparin. heparin 2. aptt. 2. salsalate aptt aptt heparin heparin warfarin 0 heparin 25 units/kg/hr aspirin 3. protamine sulfate heparin ( ) 20,000 units/day 3-4 7

8 7.2 heparin. -20 ( 5-9 )heparin 2. 00,000 heparin heparin. heparin 2. heparin AST ALT heparin warfarin, 8 Heparin protamine sulfate mg protamine sulfate 90 units heparin 00 units heparin calcium 5 units heparin sodium 00 units heparin 0 % Xa protamine Protamine 50 mg 00 mg. Heparin Protamine Heparin 30 min 8 Protamine Sulfate -.5 mg for each 00 units of heparin in last dose min mg for each 00 units of heparin in last dose 20 min mg for each 00 units of heparin in last dose Heparin mg after infusion is stopped

9 2. heparin Protamine Ardeparin Dalteparin LMWH 8 hr 8-2 hr 2 hr mg/00 antifactor mg/00 antifactor 0.5 mg/00 antifactor 0.5 mg/00 antifactor Not necessary Not necessary Enoxaparin mg/mg 0.5 mg/ mg Not necessary Tinzaparin mg/00 antifactor 0.5 mg/00 antifactor Not necessary,. Heparin 2. 25,000 units heparin 500 mld 5 W heparin heparin 400 units/hour Infuse at 8 ml/hour 500 units/hour Infuse at 0 ml/hour 00 units/hour Infuse at 2 ml/hour 700 units/hour Infuse at 4 ml/hour 800 units/hour Infuse at ml/hour 900 units/hour Infuse at 8 ml/hour 000 units/hour Infuse at 20 ml/hour 00 units/hour Infuse at 22 ml/hour 200 units/hour Infuse at 24 ml/hour 300 units/hour Infuse at 2 ml/hour 400 units/hour Infuse at 28 ml/hour 500 units/hour Infuse at 30 ml/hour 00 units/hour Infuse at 32 ml/hour 700 units/hour Infuse at 34 ml/hour 800 units/hour Infuse at 3 ml/hour 900 units/hour Infuse at 38 ml/hour 2000 units/hour Infuse at 40 ml/hour 3. heparin NTG 9

10 . Drug Information Handbook 0 th ed., 57-0 ( ). 2. Hirsh J. Dalen J. Anderson DR. Poller L. Bussey H. Ansell J. Deykin D. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest. 9 ( Suppl): 8S-2S, Hirsh J. Dalen J. Guyatt G. American College of Chest Physicians. The sixth (2000) ACCP guidelines for antithrombotic therapy for prevention and treatment of thrombosis. American College of Chest Physicians. Chest. 9( Suppl): S-2S, Hirsh J. Warkentin TE. Shaughnessy SG. Anand SS. Halperin JL. Raschke R. Granger C. Ohman EM. Dalen JE. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 9( Suppl): 4S-94S, Nutescu E. Racine E. Traditional versus modern anticoagulant strategies: summary of the literature. American Journal of Health-System Pharmacy. 59(20 Suppl ): S7-4, Anderson DM, Tallian KB. Heparin and low molecular weight heparin, 2nd ed. Murphy, JE: Clinical Pharmacokinetics Pocket Reference, 5-203, Becker RC, Corrao JM, Bovill EG, et al. Intravenous nitroglycerin induced heparin resistance: a qualitative antithromcin III abnormality. Journal of American Heart. 9:254-, Heparin. In: ToxPoints System, Micromedex, Inc.;