Unfractionated heparin anticoagulation using estimated blood volume based dosing versus weight-based dosing in a Veteran population.

OBJECTIVE: The purpose of this study is to compare estimated blood volume (EBV) versus weight-based (WB) dosing of unfractionated heparin in terms of safety and ability to achieve therapeutic antifactor-Xa (AF-Xa) levels. METHODS: This was a retrospective, cohort study including 32 male veterans who received UFH. Primary outcome measures included time until therapeutic anticoagulation, number of adjustments needed to achieve therapeutic anticoagulation, median AF-Xa levels and the percentage of patients who were therapeutic after the first and second levels. Safety was determined as the incidence of major and minor bleeding. RESULTS: EBV dosing may be associated with a decrease in the average time to therapeutic range (20.4 ± 16.7 hours with EBV vs. 26.8 ± 26 hours with WB; p = 0.404) and an increase in the percentage of patients achieving therapeutic anticoagulation after the first AF-Xa level (50% with EBV vs. 35.7% with WB; p = 0.611) although these results were not statistically significant. WB dosing required fewer adjustments (2.7 ± 2.9 with WB vs. 4 ± 2.6 with EBV; p = 0.192) with more patients within the therapeutic range after the second AF-Xa level (42.9% with WB vs. 33.3% with EBV; p = 0.897). There was one major and three minor bleeds in the WB dosing group versus one minor bleed for the EBV dosing cohort (p = 0.438 and p = 0.323, respectively). CONCLUSION: EBV dosing achieved quick therapeutic anticoagulation with less bleeding compared to WB dosing in a veteran population. Due to the study's limitations, larger, randomized, comparative trials are needed to confirm our findings.

Clinical experience with ranolazine in a veteran population with chronic stable angina.

BACKGROUND: Efficacy of ranolazine in the treatment of chronic stable angina (CSA) has been established; however, pivotal trials did not require the optimization of conventional antianginal drug therapy (CADT) prior to use in a veteran population. OBJECTIVE: To determine whether ranolazine, when added to optimized doses of CADT, improves angina in a veteran population with CSA and refractory symptoms. METHODS: In an observational retrospective study, 35 patients prescribed ranolazine and having a baseline Seattle Angina Questionnaire (SAQ) administered at a Veterans Affairs medical center in Gainesville, FL, were evaluated. Patients who were prescribed ranolazine by a provider from outside the institution and did not obtain a baseline SAQ were excluded. The primary outcome measure was the change in SAQ scores from baseline to 1 and 3 months after initiation of ranolazine treatment. Secondary measures included clinically significant QTc interval prolongation (>500 msec or an increase of at least 60 msec from baseline), adverse drug reactions, discontinuation rates, and drug-drug interactions. RESULTS: The addition of ranolazine to optimized CADT was associated with improvement in all dimensions of the SAQ scores at 1 and 3 months compared to baseline scores (p < 0.001 for all dimensions). Mean changes in SAQ dimension scores at 1 and 3 months, respectively, were as follows: physical limitation, +9.86 and +11.94; angina stability, +39.29 and +32.69; angina frequency, +26.79 and +25.38; treatment satisfaction, +11.38 and +10.66; and disease perception, +16.85 and +18.59. Improvments in all dimensions, except treatment satisfaction, were clinically significant as defined by set criteria. Of the 7 patients whose ranolazine dosages were increased to 1000 mg twice daily, only 2 patients were able to maintain treatment at that dosage. CONCLUSIONS: Ranolazine added to optimized doses of CADT demonstrated an improvement in angina symptoms when given to a veteran population with persistent CSA.