PMID- 26951166
OWN - NLM
STAT- MEDLINE
DCOM- 20170331
LR  - 20181113
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Linking)
VI  - 42
IP  - 2
DP  - 2016 Aug
TI  - Intravenous heparin dosing strategy in hospitalized patients with atrial 
      dysrhythmias.
PG  - 179-85
LID - 10.1007/s11239-016-1347-2 [doi]
AB  - Patients with non-valvular atrial fibrillation (AF) have an elevated stroke risk 
      that is 2-7 times greater than in those without AF. Intravenous unfractionated 
      heparin (UFH) is commonly used for hospitalized patients with atrial fibrillation 
      and atrial flutter (AFL) to prevent stroke. Dosing strategies exist for 
      intravenous anticoagulation in patients with acute coronary syndromes and venous 
      thromboembolic diseases, but there are no data to guide providers on a dosing 
      strategy for intravenous anticoagulation in patients with AF/AFL. 996 
      hospitalized patients with AF/AFL on UFH were evaluated. Bolus dosing and initial 
      infusion rates of UFH were recorded along with rates of stroke, thromboemobolic 
      events, and bleeding events as defined by the International Society on Thrombosis 
      and Haemostasis criteria. Among 226 patients included in the analysis, 76 
      bleeding events occurred. Using linear regression analysis, initial rates of 
      heparin infusion ranging from 9.7 to 11.8 units/kilogram/hour (U/kg/h) resulted 
      in activated partial thromboplastin times that were within therapeutic range. The 
      median initial infusion rate in patients with bleeding was 13.3 U/kg/h, while in 
      those without bleeding it was 11.4 U/kg/h; p = 0.012. An initial infusion rate 
      >11.0 U/kg/h yielded an OR 1.95 (1.06-3.59); p = 0.03 for any bleeding event. 
      Using IV heparin boluses neither increased the probability of attaining a 
      therapeutic aPTT (56.1 vs 56.3 %; p = 0.99) nor did it significantly increase 
      bleeding events in the study (35.7 vs 31.3 %; p = 0.48). The results suggest that 
      higher initial rates of heparin are associated with increased bleeding risk. From 
      this dataset, initial heparin infusion rates of 9.7-11.0 U/kg/h without a bolus 
      can result in therapeutic levels of anticoagulation in hospitalized patients with 
      AF/AFL without increasing the risk of bleeding.
FAU - Roswell, Robert O
AU  - Roswell RO
AD  - The Leon H. Charney Division of Cardiology, The Department of Medicine, New York 
      University School of Medicine, 550 First Ave, NBV 10W17, New York, NY, 10016, 
      USA. roswer01@nyumc.org.
FAU - Greet, Brian
AU  - Greet B
AD  - The Leon H. Charney Division of Cardiology, The Department of Medicine, New York 
      University School of Medicine, 550 First Ave, NBV 10W17, New York, NY, 10016, 
      USA.
FAU - Shah, Sunny
AU  - Shah S
AD  - The Leon H. Charney Division of Cardiology, The Department of Medicine, New York 
      University School of Medicine, 550 First Ave, NBV 10W17, New York, NY, 10016, 
      USA.
FAU - Bernard, Samuel
AU  - Bernard S
AD  - The Leon H. Charney Division of Cardiology, The Department of Medicine, New York 
      University School of Medicine, 550 First Ave, NBV 10W17, New York, NY, 10016, 
      USA.
FAU - Milin, Alexandra
AU  - Milin A
AD  - The Leon H. Charney Division of Cardiology, The Department of Medicine, New York 
      University School of Medicine, 550 First Ave, NBV 10W17, New York, NY, 10016, 
      USA.
FAU - Lobach, Iryna
AU  - Lobach I
AD  - The Leon H. Charney Division of Cardiology, The Department of Medicine, New York 
      University School of Medicine, 550 First Ave, NBV 10W17, New York, NY, 10016, 
      USA.
FAU - Guo, Yu
AU  - Guo Y
AD  - The Leon H. Charney Division of Cardiology, The Department of Medicine, New York 
      University School of Medicine, 550 First Ave, NBV 10W17, New York, NY, 10016, 
      USA.
FAU - Radford, Martha J
AU  - Radford MJ
AD  - The Leon H. Charney Division of Cardiology, The Department of Medicine, New York 
      University School of Medicine, 550 First Ave, NBV 10W17, New York, NY, 10016, 
      USA.
FAU - Berger, Jeffrey S
AU  - Berger JS
AD  - The Leon H. Charney Division of Cardiology, The Department of Medicine, New York 
      University School of Medicine, 550 First Ave, NBV 10W17, New York, NY, 10016, 
      USA.
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Coronary Syndrome
MH  - Anticoagulants/therapeutic use
MH  - Arrhythmias, Cardiac/complications/*drug therapy
MH  - Blood Coagulation/drug effects
MH  - Dose-Response Relationship, Drug
MH  - Heart Atria/*physiopathology
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Hospitalization
MH  - Humans
MH  - Infusions, Intravenous
MH  - Partial Thromboplastin Time
MH  - Stroke/prevention & control
MH  - Thromboembolism
OTO - NOTNLM
OT  - Atrial fibrillation
OT  - Bleeding
OT  - Cardiology-arrhythmia
OT  - Heparin
OT  - Stroke
EDAT- 2016/03/10 06:00
MHDA- 2017/04/01 06:00
CRDT- 2016/03/09 06:00
PHST- 2016/03/09 06:00 [entrez]
PHST- 2016/03/10 06:00 [pubmed]
PHST- 2017/04/01 06:00 [medline]
AID - 10.1007/s11239-016-1347-2 [pii]
AID - 10.1007/s11239-016-1347-2 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2016 Aug;42(2):179-85. doi: 10.1007/s11239-016-1347-2.