Excess heparin dosing among fibrinolytic-treated patients with ST-segment elevation myocardial infarction

The American Journal of Medicine
Tracy Y WangMatthew T Roe

Abstract

Although the use of heparin with fibrinolytics is associated with more rapid ST-segment resolution and increased infarct-related artery patency among patients with ST-segment elevation myocardial infarction (STEMI), its associated increase in bleeding risk is well documented and might be augmented by excess heparin dosing. We sought to characterize the incidence and associated bleeding risk of excess heparin dosing among patients with STEMI treated with fibrinolysis who were enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines initiative. Excess dosing was defined as a bolus more than 60 U/kg or an infusion more than 12 U/kg/h per American College of Cardiology/American Heart Association guidelines and was further stratified into major and mild excess (major defined as a bolus>70 U/kg or infusion >15 U/kg/h). Among 964 fibrinolytic-treated patients with STEMI, 758 (79%) received adjunctive unfractionated heparin therapy. Of these, 368 patients (49%) received excess dosing of unfractionated heparin and 137 patients (18%) received major excess heparin dosing. Factors significantly as...Continue Reading

References

Jul 30, 1999·American Heart Journal·J S HochmanB De La Fuente
May 4, 2000·The American Journal of Cardiology·C P Cannon
Feb 1, 2003·European Heart Journal·Frans Van de WerfUNKNOWN Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology
Mar 11, 2005·The New England Journal of Medicine·Marc S SabatineUNKNOWN CLARITY-TIMI 28 Investigators
Nov 8, 2005·Lancet·Z M ChenUNKNOWN COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group
Dec 29, 2005·JAMA : the Journal of the American Medical Association·Karen P AlexanderUNKNOWN CRUSADE Investigators
Mar 16, 2006·The New England Journal of Medicine·Elliott M AntmanUNKNOWN ExTRACT-TIMI 25 Investigators
Mar 16, 2006·JAMA : the Journal of the American Medical Association·Salim YusufUNKNOWN OASIS-6 Trial Group

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Citations

Sep 28, 2010·Expert Opinion on Drug Safety·Amar KrishnaswamyChristopher P Cannon
Jul 9, 2009·British Journal of Hospital Medicine·Daniel M SadoSajiram Sarvananthan

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