PMID- 24218420
OWN - NLM
STAT- MEDLINE
DCOM- 20140704
LR  - 20131112
IS  - 1872-9061 (Electronic)
IS  - 0300-2977 (Linking)
VI  - 71
IP  - 9
DP  - 2013 Nov
TI  - Monitoring of unfractionated heparin in critically ill patients.
PG  - 466-71
AB  - BACKGROUND: In critically ill patients, dosing of unfractionated heparin (UFH) is 
      difficult due to unpredictable pharmacokinetics, which has an impact on the time 
      to reach therapeutic anticoagulation. We evaluated the quality of UFH therapy in 
      critically ill patients in terms of activated partial thromboplastin time (APTT) 
      test values and time to therapeutic range. METHODS: Patients admitted to the 
      Intensive Care Unit (ICU) and Medium Care Unit (MCU) were screened for 
      intravenous UFH administration. Time to therapeutic range was categorised into 
      0-12, 13-24 and >24 hours. APTT results were classified into categories of 
      subtherapeutic, supratherapeutic and therapeutic tests. We identified to what 
      extent the sub- and upratherapeutic values were aberrant of the limit of the 
      therapeutic range (15%). RESULTS: In 101 patients admitted to the ICU and MCU, 
      time to therapeutic range was 24 hours in 56% of the population, whereas in 10% 
      of the patients no therapeutic APTT was achieved during UFH treatment. Among the 
      APTT levels, 29% of all test results measured in 24 hours were within the 
      therapeutic range. Subtherapeutic values were found in 53% of the test results, 
      of which 160/203 were more than 15% under the lower limit, whereas 18% of the 
      test results were supratherapeutic, of which 40/69 more than 15% above the upper 
      limit. CONCLUSION: In this cohort of critically ill patients, therapeutic APTT 
      values were reached within 24 hours in 56% of the patients. We conclude that 
      intravenous UFH therapy can be improved in critically ill patients.
FAU - Aarab, R
AU  - Aarab R
AD  - Department of Vascular Medicine, Academic Medical Centre, University of 
      Amsterdam, Amsterdam, the Netherlands.
FAU - van Es, J
AU  - van Es J
FAU - de Pont, A C J M
AU  - de Pont AC
FAU - Vroom, M B
AU  - Vroom MB
FAU - Middeldorp, S
AU  - Middeldorp S
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Netherlands
TA  - Neth J Med
JT  - The Netherlands journal of medicine
JID - 0356133
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/administration & dosage/pharmacokinetics/*therapeutic use
MH  - Critical Illness/*therapy
MH  - Dose-Response Relationship, Drug
MH  - Drug Monitoring/*methods
MH  - Female
MH  - Heparin/administration & dosage/pharmacokinetics/*therapeutic use
MH  - Humans
MH  - Infusions, Intravenous
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - *Partial Thromboplastin Time
MH  - Patient Admission
MH  - Thromboembolism/prevention & control
MH  - Time Factors
MH  - Young Adult
EDAT- 2013/11/13 06:00
MHDA- 2014/07/06 06:00
CRDT- 2013/11/13 06:00
PHST- 2013/11/13 06:00 [entrez]
PHST- 2013/11/13 06:00 [pubmed]
PHST- 2014/07/06 06:00 [medline]
PST - ppublish
SO  - Neth J Med. 2013 Nov;71(9):466-71.