Abstract: . . .  4/6/04 8:42 AM Page 11 Page 12 therapeutic aPTT range of 60 to 100 seconds, is described in Table 16-7. REVERSAL OF EFFECT 14. P.B. is a 64-year-old woman with DVT. On day 4 of hep- arin therapy, she received 25,000 U of heparin during a 1-hour period as a result of an infusion pump malfunction. The infusion was stopped and within 30 minutes, she became diaphoretic and hypotensive. Bright red blood was evident upon rectal examina-  . . .
. . .  L.N.s Hct has dropped from a baseline of 36.5% to 29%, and blood is noted in his urine. De- scribe an approach to evaluate and interpret this event. Hemorrhage. Bleeding is the most common adverse effect associated with heparin. A summary of eight inception cohort studies reporting heparin-associated bleeding found the ab- solute frequency of fatal, major, and all (major or minor) bleeding to be 0.4%, 6%, and 16%, respectively. 26 The corre- sponding average daily frequencies were 0.05% for fatal bleeding, 0.8% for major bleeding, and 2% for major or mi- nor bleeding; cumulative risk increased with the duration of therapy. The most common sites for heparin-associated . . .
. . .  such as urticaria, rash, rhinitis, conjunctivitis, asthma, and angioedema, as well as a reversible temporal alopecia. 5 ADJUSTED-DOSE SUBCUTANEOUS ADMINISTRATION 13. By day 4 of heparinization, IV access for L.N. has become difficult. What alternatives can be considered? The most common strategy for treatment of venous throm- bosis in hospitalized patients without IV access is the use of SC LMWH (see Question 15). Another alternative is SC ad- ministration of unfractionated heparin with adjustment of dosing to maintain a therapeutic aPTT. 29 Typically, SC heparin is administered at 12-hour intervals and aPTT is monitored at the mid-dosing . . .
. . .  dose should be simplified to 20,000 U SC every 12 hours. L.N.s aPTT should be checked 6 hours after the first dose, with adjustment of dosing as necessary. Because of the reduced bioavailability of SC heparin in comparison with IV administration, increased dosing may be required. A weight-based dosing nomogram, specific for a reagent with a THROMBOSIS 16- 11 Koda-Kimble_Ch16_001-034 4/6/04 8:42 AM Page 11 Page 12 therapeutic aPTT range of 60 to 100 seconds, is described in Table 16-7. REVERSAL OF EFFECT 14. P.B. is a 64-year-old woman with DVT. On day 4 of hep- arin therapy, she received 25,000 U of heparin . . .
--3000,4,375,3088,64553