2015肝素抗凝治疗的临床监测剖析.ppt

According to the CHEST guidelines, the PTT therapeutic range is determined by correlating PTT values with an unfractionated heparin level of 0.3 to 0.7 (IU/mL). ? (To find the APTT that corresponds to those heparin concentrations)…..At 0.3, draw a line up to the linear regression line and the PTT that correlates to that is 55 seconds (in this example). ? On the upper end at 0.7, draw a line up to the linear regression line and across, you will see the PTT time in seconds that corresponds to 0.7 is 85 seconds. You have now successfully established the PTT therapeutic range of 55 - 85 seconds (in this example). (Speaker’s notes – pharmacy will base their UFH dosing nomogram on this therapeutic range) * However, according to the CHEST guidelines, the Anti-Xa therapeutic range for VTE is 0.3-0.7. (Speaker’s note – that is the vertical area shaded in purple(ish) ? ? ? ? ? ? ? * Now lets look at a few patient results (begin from Left to Right): The 1st patient circled on left has a PTT of approximately 75 seconds. This patients PTT result is therapeutic. Remember, in this example, the PTT therapeutic range is 55-85 seconds. However the Anti-Xa level is 0.2 which means the patient is actually subtherapeutic. Based on the PTT, no change is required to the heparin dosing. However this patient may be at risk for a thrombosis (clotting). This patient is not therapeutic and may be under-anticoagulated. (Ask)…Is the patient therapeutic or is the result therapeutic???? (Speaker’s note – What is this patient at risk for? They are actually at risk to clot! Patient is subtherapeutic). 2. (2nd circled result) The next patients PTT result is ~35 seconds circled in the middle of this graph. Based on this PTT result, this patient is subtherapeutic... 55 seconds (below the therapeutic range) and the heparin dosing would be increased. In actuality, this patient is therapeutic, they are within 0.3-0.7 therapeutic range for an Anti-Xa assay. The heparin dose for this patie