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Evidence-based Cardiology – part 6

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Các chế độ được đề nghị là 60 IU / kg như là một viên thức ăn lúc khởi đầu của truyền alteplase, sau đó một liều duy trì ban đầu khoảng 12 IU / kg / giờ (tối đa 4.000 viên thức ăn IU và 1000 truyền tối đa IU / giờ cho các bệnh nhân nặng 70 kg), | Evidence-based Cardiology Table 33.5 Recommendations for the use of adjunctive unfractionated heparin with fibrinolytic therapy from two consensus conferences Fibrinolytic agent ACC AHA 199934 ACCP 200091 Fibrin-specific agents Intravenous unfractionated heparin should be used in patients undergoing reperfusion therapy with alteplase. The recommended regimen is 60IU kg as a bolus at initiation of the alteplase infusion then an initial maintenance dose of approximately 12IU kg hour maximum 4000IU bolus and maximum 1000IU hour infusion for patients weighing 70 kg adjusted to maintain the APTT at 1-5-2-0 times control 50-70 seconds for 48 hours. Continuation of the heparin infusion beyond 48 hours should be considered in patients at high risk of systemic or venous thromboembolism Streptokinase Intravenous unfractionated heparin should be used in patients at high risk of systemic emboli large or anterior MI atrial fibrillation previous embolus or known left ventricular thrombus . It is recommended that heparin be withheld for 6 hours and that APTT testing begin at that time. Heparin should be started when the APTT returns to 2 times control approximately 70 seconds then infused to keep the APTT at 1.5-2.0 times control initial infusion rate approximately 1000 IU hour . After 48 hours a change to subcutaneous heparin warfarin or aspirin alone should be considered Patients receiving alteplase reteplase or tenecteplase should be given intravenous unfractionated heparin for 48 hours. Either standard dosing a 5000IU bolus and 1000 IU hour infusion or weight adjusted dosing a 60 IU kg bolus maximum 4000 IU and 12 IU kg hour infusion maximum 1000 IU hour may be used both adjusted to maintain an APTT of 50-70 seconds Patients at high risk of systemic or venous thromboembolism that is those with Q wave anterior MI severe left ventricular dysfunction congestive heart failure a history of systemic or pulmonary embolism evidence of left ventricular thrombus or atrial fibrillation