ABSTRACT
Heparin is one of the current necessary medications in Acute MI Regarding narrow therapeutic dose and unpredictable pharmacokinetics of heparin, its anticoagulant effect should be measured precisely .Despite widely utilized heparin in method of intermittent fixed dose, body weight independent IV administration our data about the range of aPTT as a monitoring marker is quite limited thus we prepared the study to measure if the custom method fills the target therapeutic range. The study was performed cross-sectionally on 250 patients with acute MI admitted in cardiology department of Imam Reza hospital in 2001, receiving heparin 5000 units Q4h and having daily aPTT on three Sequential days. The data was gathered by a checklist and analyzed with SPSS software. 14.8% of patients had a mean aPTT level of therapeutic range and 1.2% of patients had a mean aPTT level of more than therapeutic range and remarkably 84% of patients never acheived therapeutic range. Despite tolerability of this method by patients and staff, above results necessitate reconsideration in dose and interval of heparin administration in custom method [5000 unit IV Q4h] or changing into methods of continuous infusion or using subcutaneous low molecular weight heparins
Subject(s)
Humans , Myocardial Infarction/drug therapy , Heparin/adverse effects , Heparin , Heparin/administration & dosage , Heparin/pharmacokinetics , Cross-Sectional StudiesSubject(s)
Humans , Heparin, Low-Molecular-Weight/administration & dosage , Heparin, Low-Molecular-Weight/adverse effects , Heparin, Low-Molecular-Weight/pharmacokinetics , Heparin, Low-Molecular-Weight/pharmacology , Heparin/administration & dosage , Heparin/pharmacokinetics , Heparin/pharmacology , Heparin/therapeutic use , Thrombin , Thrombin/administration & dosage , Thrombin/antagonists & inhibitors , Thrombin/pharmacokinetics , Thrombin/pharmacology , Thrombin/therapeutic useSubject(s)
Humans , Anticoagulants/administration & dosage , Anticoagulants/standards , Cardiovascular Diseases/drug therapy , Aspirin/pharmacokinetics , Atherosclerosis/drug therapy , Brain Ischemia/drug therapy , Platelet Glycoprotein GPIIb-IIIa Complex/pharmacokinetics , Coronary Disease/drug therapy , Dipyridamole/pharmacokinetics , Heart Valve Diseases/drug therapy , Atrial Fibrillation/drug therapy , Heart Valve Prosthesis , Heparin/pharmacokinetics , Pregnancy Complications/drug therapy , Pulmonary Embolism/drug therapy , Ticlopidine/pharmacokinetics , Venous Thrombosis/drug therapyABSTRACT
Os autores mostram a importância e aplicaçäo clínica no momento atual dos antiplaquetários, anticoagulantes orais, heparina venosa e subcutânea, heparina de baixo peso molecular e os trombolíticos. Chamam a atençäo quanto à interaçäo necessária entre cardiologistas, hematologistas, angiologistas e cirurgiöes no tratamento antitrobótico.
Subject(s)
Anticoagulants/therapeutic use , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/drug therapy , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/pharmacokinetics , Heparin/adverse effects , Heparin/pharmacokinetics , Thrombolytic Therapy/trendsSubject(s)
Humans , Male , Aged , Renal Dialysis/methods , Heparin/pharmacology , Renal Insufficiency, Chronic/therapy , Heparin, Low-Molecular-Weight/pharmacokinetics , Heparin, Low-Molecular-Weight/pharmacology , Heparin/adverse effects , Heparin/pharmacokinetics , Partial Thromboplastin Time , Uremia/drug therapyABSTRACT
Neste trabalho é apresentada a proposta para a determinação de componentes do sangue humano in vivo, através da utilização da espectroscopia Raman. A obtenção das quantidades de glucose e de gases dissolvidos no sangue por via transcutânea, remotamente e em tempo real, utilizando fibras ópticas, demonstra-se de grande utilidade para a rápida tomada de decisão em um ambiente hospitalar. A utilização de um dispositivo especialmente projetado para aumentar a coleta de luz pelo sistema de fibras ópticas amplia as perspectivas de utilização da técnica.
ln this work we present the proposal for obtaining human blood components in vivo, using Raman spectroscopy. The determination of glucose and disolved gases quantities in the whole blood transcutaneously, remotely and in real time by meaning of fiber optics, shows be very important for rapid decision in an hospital environment. The use of a Subject(s)
Humans
, Spectrum Analysis, Raman/instrumentation
, Blood Gas Monitoring, Transcutaneous/methods
, Heparin/pharmacokinetics
, Fluorescence
, Lasers
, Optical Fibers
Subject(s)
Humans , Animals , Female , Breast Neoplasms/drug therapy , Breast Neoplasms/therapy , Capillaries , Growth Substances/adverse effects , Angiogenesis Inhibitors , Molecular Biology , Neoplasm Metastasis , Prognosis , Antigens, Differentiation/classification , Apoptosis/drug effects , Biological Treatment , Cytotoxicity, Immunologic , Drug Resistance, Neoplasm , Endothelial Growth Factors , Heparin/pharmacokinetics , Immunohistochemistry , Necrosis/physiopathology , Neoplasm Recurrence, Local , Poisons/therapeutic use , Pentosan Sulfuric Polyester/pharmacokinetics , Prostatic Neoplasms/therapy , Heat-Shock Proteins/therapeutic useABSTRACT
The aim of this work was to compare the benefits and problems of low molecular weight heparin use in chronic hemodialysis, compared to conventional heparin. We studied 35 patients that received low molecular weight heparine (Enoxaparine, molecular weight 4000) during 115 consecutive hemodialysis procedures and conventional heparin during the subsequent 35 procedures. We assessed the heparin dose, partial thromboplastin time before dialysis and at 3 and 120 min during the procedure, arterio-venous fistula compression time, clot formation in the circuit and residual volume of filters. Median total dose of conventional heparin was 6289 U (range 3000-10000) compared to 5555 U (range 2000-8000) of low molecular weight heparin. When the dose was calculated per kg of body weight, it was lower for low molecular weight heparin than for conventional heparin (87.8 U (range 33-100) vs 100 U (range 50-176). Partial thromboplastin time achieved was lower with low molecular weight heparin, compared with conventional heparin, at 3 (64.26 vs 125.2 sec) and 120 min (39.1 vs 84.45 sec). Clot formation, arteriovenous fistula compression time and residual volume of filters were similar for both types of heparin. It is concluded that a single dose of low molecular weight heparin simplifies anticoagulation during hemodialysis, modifies less the partial thromboplastin time and does not alter filter re-utilization
Subject(s)
Humans , Male , Female , Heparin/administration & dosage , Enoxaparin/administration & dosage , Renal Dialysis/methods , Hemodialysis Solutions/pharmacology , Partial Thromboplastin Time , Heparin/pharmacokinetics , Enoxaparin/pharmacokineticsABSTRACT
Los estudios farmacocinéticos de la heparina no fraccionada en insuficiencia renal crónica han dado resultados variables, no habiendo uniformidad en las dosis utilizadas ni comparación con grupos de controles. La cinética de heparina en el transcurso de hemodiálisis es poco conocida, dado el empleo de esquemas de heparinización que consisten en pulsos iniciales seguidos por infusiones con bomba. Asimismo, tampoco se conocen las variaciones de la actividad heparínica en los diferentes tiempos de diálisis luego de una dosis única inicial. En este trabajo demostramos, con diferentes técnicas (TCK, TPTWB, heparinemias con PTTK en diluciones de plasma y actividad anti-Xa) que la vida media de la heparina no fraccionada a dosis bajas no es modificada por la función renal, siendo la eliminación exponencial de primer orden. A dosis altas la vida media está prolongada en pacientes con insuficiencia renal crónica respecto al grupo de control, presentando una cinética compleja, con diferentes pendientes de eliminación. El estudio de cinética en hemodiálisis con dosis única inicial mostró que la vida media esta prolongada 3 veces por sobre los niveles basales y que dicha prolongación estaría vinculada a la persistencia de heparinemias altas por contracción de volumen en la primera hora, provocando mayor influencia en los mecanismos de depuración que la dosis misma. La actividad de la heparina inyectada sufre considerables variaciones en el curso de la hemodiálisis, con un marcado efecto neutralizante del plasma urémico sobre la actividad anti-Xa en el comienzo (relación de actividad Anti-Xa/PTTK disminuida) y aumento progresivo de la actividad anti-Xa al final de la misma. De la comparación de pruebas ex vivo e in vitro de la actividad de heparina no fraccionada y del efecto in vitro de fragmentos de clivaje con heparinasa sobre plasma urémico surge que el efecto neutralizante del plasma urémico sobre la actividad anti-Xa es dependiente del peso molecular y que el aumento progresivo de la actividad anti-Xa hacia el final de la hemodiálisis probablemente se deba a la persistencia de los fragmentos de menor peso molecular de la heparina inyectada o a la liberación de glicosaminoglicanos endógenos por la propia heparina
Subject(s)
Humans , Adult , Middle Aged , Heparin/pharmacokinetics , Renal Dialysis , Heparin/administration & dosage , Heparin/therapeutic use , Half-Life , Renal Insufficiency, Chronic/therapySubject(s)
Adult , Middle Aged , Humans , Male , Female , Heparin/pharmacokinetics , Renal Dialysis/methods , Hemodialysis Solutions , Heparin/administration & dosageABSTRACT
Se evalúan las variaciones de la permeabilidad del peritoneo de la rata durante las primeras horas de una peritonitis y se determina la función de la heparina en la absorción peritoneal, inyectando Tc 99 en la cavidad y midiendo con gamma cámara la reactividad residual a las 12 hs. No se observaron diferencias estadísticamente significativas entre el grupo control y los con peritonitis y con peritonitis más heparina. La distribución y captación del Tc 99 fue uniforme, excepto en 3 animales del grupo de peritonitis sin heparina que mostraron menor captación en un área de la región inferior del abdómen. Se observó una importante exudación en la cavidad peritoneal al parecer superior a la absorción. Se puede deducir que las endotoxinas bacterianas se incorporarían lenta y progresivamente a través de la membrana, cumpliendo en la sepsis un rol secundario durante las primeras horas de una peritonitis.