PMID- 18758089
OWN - NLM
STAT- MEDLINE
DCOM- 20081231
LR  - 20190819
IS  - 1346-9843 (Print)
IS  - 1346-9843 (Linking)
VI  - 72
IP  - 10
DP  - 2008 Oct
TI  - The time has come for new, more precise guidelines in the treatment of high-risk 
      acute coronary syndromes with heparin.
PG  - 1674-9
AB  - BACKGROUND: The aim of this analysis was to define the risk factors associated 
      with the problematic dose titration of unfractionated heparin (UFH) in high-risk 
      non-ST-segment elevation acute coronary syndrome (NSTE ACS) patients. METHODS AND 
      RESULTS: The study group comprised 267 patients with high-risk NSTE ACS managed 
      with an early invasive strategy and treated with the recommended dose of UFH. The 
      subsequent dose was adjusted after measurement of activated partial 
      thromboplastin time (aPTT), using the nomogram. The goal for aPTT was 
      1.5-2.5-fold of the control value. At 6 h after starting therapy 29% of patients 
      had a therapeutic initial aPTT value; half of them were over-anticoagulated, and 
      22% were undertreated. By continuing therapy, the proportion of optimally treated 
      patients increased; after 12 h of treatment 40% of patients reached the 
      therapeutic dose, and 58% after 24 h. Undertreatment was a problem in < or = 
      65-year-old men. Women and older patients have a higher risk of overdose. The 
      patients with a therapeutic dose of UFH had the lowest occurrence of major 
      ischemic adverse events. CONCLUSIONS: Expert consensus on more precise dose 
      guidelines for UFH is needed. The dose needs to be not only weight, but also age 
      and sex, adjusted.
FAU - Motovska, Zuzana
AU  - Motovska Z
AD  - Third Faculty of Medicine, Charles University and Cardiocentre University 
      Hospital Kralovske Vinohrady, Prague, Czech Republic. zuzana.motovska@iex.cz
FAU - Widimsky, Petr
AU  - Widimsky P
FAU - Petr, Robert
AU  - Petr R
FAU - Andrasova, Andrea
AU  - Andrasova A
FAU - Bilkova, Dana
AU  - Bilkova D
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20080901
PL  - Japan
TA  - Circ J
JT  - Circulation journal : official journal of the Japanese Circulation Society
JID - 101137683
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/therapeutic use
MH  - Body Mass Index
MH  - Body Weight
MH  - Coronary Care Units
MH  - Creatinine/metabolism
MH  - Czech Republic
MH  - Dose-Response Relationship, Drug
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Kidney Function Tests
MH  - Middle Aged
MH  - Practice Guidelines as Topic
MH  - Sex Characteristics
EDAT- 2008/09/02 09:00
MHDA- 2009/01/01 09:00
CRDT- 2008/09/02 09:00
PHST- 2008/09/02 09:00 [pubmed]
PHST- 2009/01/01 09:00 [medline]
PHST- 2008/09/02 09:00 [entrez]
AID - JST.JSTAGE/circj/CJ-07-1083 [pii]
AID - 10.1253/circj.cj-07-1083 [doi]
PST - ppublish
SO  - Circ J. 2008 Oct;72(10):1674-9. doi: 10.1253/circj.cj-07-1083. Epub 2008 Sep 1.