Therapeutic drug monitoring
-
Comparative Study
Comparison of 2 weight-based heparin dosing nomograms in neurology and vascular surgical patients.
Unfractionated heparin sodium (UFH) is used in neurology and vascular surgical patients to treat and prevent thromboembolic occlusions and requires weight-based dosing to achieve a therapeutic range; however, the optimal dosing strategy is not known. This study sought to determine whether an intravenous (IV) weight-based UFH dosing nomogram based on an 80-unit/kg bolus and 18-unit · kg(-1) · h(-1) initial infusion rate achieves therapeutic anticoagulation [activated partial thromboplastin time (aPTT), 65-110 seconds] more rapidly than that based on a 60-unit/kg bolus and 12-unit · kg(-1) · h(-1) initial infusion rate in 98 neurology and vascular surgery patients. ⋯ A weight-based nomogram for IV UFH using an 80-unit/kg bolus and an initial infusion rate of 18 units · kg(-1) · h(-1) showed a more rapid achievement of therapeutic aPTT when compared with a 60:12 dosing nomogram. Future research assessing a 70-unit/kg bolus dose is recommended.
-
Comparative Study
Comparison of anti-Xa and activated partial thromboplastin time monitoring for heparin dosing in patients with cirrhosis.
Cirrhosis of the liver results in complex hemostatic changes that place patients at risk for both bleeding and thrombotic events. This study evaluates the adverse effects of anticoagulation with unfractionated heparin among patients with cirrhosis and analyzes the discrepancy between anti-Xa and activated partial thromboplastin time (aPTT) values for heparin monitoring among cirrhotics. ⋯ A greater use of blood products among the cirrhotic population may indicate potential bleeding events on therapy. A discrepancy in correlated anti-Xa and aPTT values among patients with cirrhosis may explain the propensity for adverse effects. Further study is required to identify effective heparin anticoagulation monitoring strategies in liver disease.
-
Previous reports have suggested that polymorphism of the opioid receptor A118G affects the efficacy of opioid analgesia. The aim of this study was to investigate whether such polymorphism contributed to variability in epidural mixture (sufentanil plus ropivacaine) requirements through patient-controlled epidural analgesia (PCEA) after cesarean section. ⋯ The analgesic requirements of patients receiving sufentanil and ropivacaine through PCEA after caesarean section were not associated with A118G polymorphism.
-
The goal of this study was to assess the safety of single bolus dose of ropivacaine (ROP) followed by continuous infusion through transversus abdominis plane block catheter. The aim was to determine ROP absorbed from the infusion site, changes in protein binding after surgery, and clinical determinants of adverse effects. ⋯ Although the total ROP concentrations approached or exceeded reported neurotoxicity thresholds, no patients had unbound ROP concentrations approaching the unbound toxicity threshold, nor showed any signs or symptoms of toxicity. This result was consistent with changes in protein binding to alpha-1 acid glycoprotein after surgery.
-
Controlled Clinical Trial
Point-of-care coagulation testing for assessment of the pharmacodynamic anticoagulant effect of direct oral anticoagulant.
This investigation was carried out with already available point-of-care testing (POCT) systems for coagulation parameters to evaluate the qualitative and semiquantitative determination of the time- and concentration-dependent anticoagulant effects of the direct oral anticoagulants rivaroxaban and dabigatran. ⋯ Direct oral anticoagulants display variable ex vivo effects on different POCT-assays. POCT for aPTT is sensitive to increased concentrations of dabigatran, whereas the PT-POCT assessed with test systems such as the GEM PCL Plus may be helpful to measure the pharmacodynamic anticoagulant effects of rivaroxaban in emergency clinical situations.