PMID- 25746584
OWN - NLM
STAT- MEDLINE
DCOM- 20151230
LR  - 20181202
IS  - 1557-8615 (Electronic)
IS  - 0883-9441 (Linking)
VI  - 30
IP  - 3
DP  - 2015 Jun
TI  - Heparin dose adjustment required to maintain goal-activated partial 
      thromboplastin time during therapeutic hypothermia.
PG  - 574-8
LID - S0883-9441(15)00049-0 [pii]
LID - 10.1016/j.jcrc.2015.01.016 [doi]
AB  - PURPOSE: The impact of therapeutic hypothermia (TH) on unfractionated heparin 
      (UFH) management is essentially unknown. The aim of this study was to evaluate 
      the effect of TH on UFH dosing and activated partial thromboplastin (aPTT) 
      response. MATERIALS AND METHODS: Consecutive patients treated from 2005 to 2011 
      who received intravenous UFH via a dosing nomogram during TH were included. 
      First, heparin doses and aPTT responses were compared between 2 core temperature 
      groups, less than or equal to 33 degrees C and greater than 35 degrees C. Next, the first aPTT, 
      drawn at 6 hours for temperature less than or equal to 33 degrees C, was assessed. 
      Lastly, a linear model was developed to predict the mean aPTT, based on 
      temperatures and heparin doses. RESULTS: Of the 156 TH patients, 68 were 
      included. At temperatures less than or equal to 33 degrees C, 76.3% of all aPTT levels 
      and 81.0% of the first aPTTs were above goal range, respectively. Using a linear 
      model, an UFH dose of 12 U/kg per hour predicts an aPTT of 134 seconds at less 
      than or equal to 33 degrees C. CONCLUSIONS: Using guideline-recommended heparin dosing 
      without dose adjustment for temperature changes produced excessive aPTT during 
      the cooling phase for TH patients. Reduction in the UFH dose of 43% to 54% may be 
      required during TH. We recommend frequent aPTT monitoring during the cooling and 
      rewarming phases to attain a desired aPTT range.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Fevold, Ryan T
AU  - Fevold RT
AD  - Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA. Electronic 
      address: fevold.ryan@mayo.edu.
FAU - Leung, Yuk Ting Lydia
AU  - Leung YT
AD  - Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA.
FAU - Garofoli, Adrian C
AU  - Garofoli AC
AD  - Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA.
FAU - White, Roger D
AU  - White RD
AD  - Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA; Division of 
      Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, 
      MN, USA.
FAU - Barsness, Gregory W
AU  - Barsness GW
AD  - Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo 
      Clinic, Rochester, MN, USA.
FAU - Dierkhising, Ross A
AU  - Dierkhising RA
AD  - Division of Biomedical Statistics and Informatics, Department of Health Sciences 
      Research, Mayo Clinic, Rochester, MN, USA.
FAU - Ou, Narith N
AU  - Ou NN
AD  - Department of Pharmacy Services, Mayo Clinic, Rochester, MN, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150129
PL  - United States
TA  - J Crit Care
JT  - Journal of critical care
JID - 8610642
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*administration & dosage
MH  - Female
MH  - Heart Arrest/*blood/therapy
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - *Hypothermia, Induced
MH  - Linear Models
MH  - Male
MH  - Middle Aged
MH  - Nomograms
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Cardiac arrest
OT  - Therapeutic hypothermia
OT  - Unfractionated heparin
EDAT- 2015/03/10 06:00
MHDA- 2015/12/31 06:00
CRDT- 2015/03/10 06:00
PHST- 2014/09/17 00:00 [received]
PHST- 2014/12/30 00:00 [revised]
PHST- 2015/01/23 00:00 [accepted]
PHST- 2015/03/10 06:00 [entrez]
PHST- 2015/03/10 06:00 [pubmed]
PHST- 2015/12/31 06:00 [medline]
AID - S0883-9441(15)00049-0 [pii]
AID - 10.1016/j.jcrc.2015.01.016 [doi]
PST - ppublish
SO  - J Crit Care. 2015 Jun;30(3):574-8. doi: 10.1016/j.jcrc.2015.01.016. Epub 2015 Jan 
      29.