PMID- 16234765
OWN - NLM
STAT- MEDLINE
DCOM- 20060404
LR  - 20170310
IS  - 0022-9040 (Print)
IS  - 0022-9040 (Linking)
VI  - 45
IP  - 10
DP  - 2005
TI  - [Deviation of activated partial thromboplastin time from optimal level after 12 
      hours of intravenous infusion of unfractionated heparin -- an independent 
      predictor of recurrence and unfavorable 30-day prognosis in patients with 
      myocardial infarction].
PG  - 27-30
AB  - Aim of the study was to assess significance of deviations of activated partial 
      thromboplastin time (APTT) from optimal level (50-75 sec) after 48 hours of 
      intravenous infusion of unfractionated heparin (UFH) in streptokinase treated 
      patients with myocardial infarction (MI) for prognosis of nonfatal reinfarction 
      and cumulative criterion comprising cardiac death, nonfatal MI and early 
      postinfarction angina. Infusion of streptokinase (1,500,000 U in 30-60 min) was 
      carried out after loading dose of aspirin (250 mg) and intravenous bolus (5,000 
      U) of UFH in 75 patients (age 34-76 years) admitted within 6 hours after onset of 
      acute ST-elevation MI. UFH infusion was started prior to termination of 
      administration of streptokinase and continued for 48 hours. During first 12 hours 
      infusion rate was 1,000 or 800 U/hour in patients with body mass > or = 80 and < 
      80 kg, respectively. During initial 12 hours infusion rate was corrected if at 6 
      hours APTT was less than 40 or exceeded 150 sec. After 12 hours a nomogram was 
      used for UFH dose adjustment according to APTT. Maximal number of optimal APTT 
      values during UFH infusion just reached 50%. During first 12 hours prevailed 
      values above 75 sec, after 24 and 36 hours -- values below 50 sec. Deviation of 
      APTT from optimal level in 12 hours after onset of UFH infusion was the only 
      independent predictor of nonfatal recurrent MI during following 30 days (relative 
      risk [RR] 9.01, 95% confidence interval [CI]1.1 to 77.2; p=0.043). Independent 
      predictors of cumulative criterion were level of risk of death according to TIMI 
      scale (RR 1.47, 95% CI 1.-3 to 2.11; p=0.036) and deviation of APTT from optimal 
      level in 12 hours after onset of UFH infusion (RR 3.24, 95%CI 1.05 to 10.5; 
      p=0.046). It should be noted that rather than suboptimal excessive 
      hypocoagulation by 12th hour of UFH infusion was associated with worse prognosis. 
      APTT levels in 6, 24, and 36 hours of UFH infusion had no prognostic significance 
      in relation to events assessed in the study.
FAU - Shalaev, S V
AU  - Shalaev SV
FAU - Shava, V P
AU  - Shava VP
FAU - Petrik, E S
AU  - Petrik ES
FAU - Pushnikova, M A
AU  - Pushnikova MA
FAU - Zhuravleva, T D
AU  - Zhuravleva TD
LA  - rus
PT  - English Abstract
PT  - Journal Article
PL  - Russia (Federation)
TA  - Kardiologiia
JT  - Kardiologiia
JID - 0376351
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.- (Streptokinase)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Electrocardiography
MH  - Fibrinolytic Agents/administration & dosage/*pharmacology/*therapeutic use
MH  - Heparin/administration & dosage/*pharmacology/*therapeutic use
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*drug therapy/mortality
MH  - Partial Thromboplastin Time/methods
MH  - Prognosis
MH  - Recurrence
MH  - Streptokinase/therapeutic use
MH  - Survival Rate
EDAT- 2005/10/20 09:00
MHDA- 2006/04/06 09:00
CRDT- 2005/10/20 09:00
PHST- 2005/10/20 09:00 [pubmed]
PHST- 2006/04/06 09:00 [medline]
PHST- 2005/10/20 09:00 [entrez]
PST - ppublish
SO  - Kardiologiia. 2005;45(10):27-30.