Comparison of the efficacy of the weight-based heparin dosing nomogram and standard method.

Nowadays, heparin is extensively used in patients with various medical diseases without standardized dose adjustment. Previous studies revealed that delayed therapeutic level achievement led to suboptimal outcome. Objective: To determine the most effective method of heparin dose adjustment and factors affecting appropriate heparin dose. Methods: All patients requiring heparin treatment were monitored for APTT ratio in phase 1 (conventional method), then randomized into Standard and Weight-based method in phase 2 with the same manner of APTT ratio monitoring. Results: Student t-test for primary outcome favored the Standard dosing heparin nomogram in comparison with conventional method at 18 h ( p-value = .0006) and 24 h ( p-value = .03) and the Weight-based nomogram at 18 h ( p-value = .02). At 24 h, 21 of 28 patients ( 75%) of the Standard nomogram group achieved the therapeutic range, comparing with 14 of 28 patients (50%) in the Weight-based nomogram group and 15 of 39 patients ( 38%) in conventional group. Only age and body weight may affect the appropriate heparin dose. Conclusion: The Standard heparin nomogram was more effective and practical in heparin dose adjustment. Factors affecting appropriate heparin dose were age and body weight.

The life threatening bilateral subdural haematoma: A case report.

Chronic subdural haematona (CSH) is one of the great mimicker in neurology and usually leading to misdiagnosis, because the symptoms and sign are variable. Most patients usually had no previous history of head injury. Bilateral subdural haematoma is even more different to diagnosis and it is one of the most life threatening condition, but fortunately it is a very rare event. We report a 52 year old man who had suffered from severe headache for 1 mouth and later developed confusion. CT scan and lumbar puncture were done at the other hospital. But the diagnosis was dubious and paracetamol was prescribed. He was referred to Siriraj Hospital by himself. Repeated lumber puncture was done and the result was still normal then he was consulted but his previous neuroimagine revealed bilateral isodensity subdural haematoma. Haemolytic clot from subdural haematoma was removed bilaterally in the same day which resulted in complete resolution of confusion and headache.