Abstract Details

Title Comparison of Existing and New Heparin Nomograms for the Treatment of Cerebrovascular Disease

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-018

Objective To compare our hospital’s existing intravenous heparin infusion (IHI) nomogram to a revised nomogram designed to reduce time to therapeutic activated partial thromboplastin time (aPTT) and minimize fluctuations in patients with cerebrovascular disease (CVD).

Background IHI is used to prevent thrombus propagation in CVD. Our hospital’s existing IHI nomogram resulted in frequent fluctuations outside therapeutic aPTT range with delayed time to therapeutic aPTT, increasing the risk for bleeding and recurrent thrombotic events.

Design/Methods We conducted a cohort study of 73 patients on the existing IHI nomogram (infusion rate 12 units/kg/hr), 64 patients on the existing IHI nomogram with aPTT checks adjusted from every 4 to 6 hours, and 85 patients on the modified IHI nomogram (infusion rate 15 units/kg/hr). Inclusion criteria required diagnosis of CVD, ages 18-90, at least 12 hours on IHI, and at least 2 aPTT. Patients with hormone therapy or anticoagulation, liver disease, or IHI nomogram deviation were excluded. Primary endpoint was achievement of therapeutic aPTT within 24 hours. Secondary endpoints include time to therapeutic aPTT, reduction of adverse bleeding events and percentage of supra- and sub-therapeutic aPTT values (paired sample t-test).

Results All patients on the modified IHI nomogram and 81% of the existing IHI nomogram patients reached therapeutic aPTT. Achievement of therapeutic aPTT within 24 hours was seen in 86% of modified IHI nomogram and 59-63% of existing IHI nomogram patients. The number of supratherapeutic aPTT increased (mean difference 0.22±0.06, p=0.0007) while the number of subtherapeutic aPTT decreased (mean difference 0.25±0.07, p=0.0006) in the modified IHI nomogram. There was no difference in adverse bleeding between nomograms (p=0.72).

Conclusions With the modified IHI nomogram, this study showed 100% achievement of therapeutic aPTT, improvement in percentage of patients obtaining therapeutic aPTT within 24 hours, and reduction in number of subtherapeutic aPTT with no difference in adverse bleeding events.

Authors/Disclosures
Shadi V. Barbu, MD (The Cole Center for Parkinson’s and Movement Disorders) PRESENTER	No disclosure on file
Justine K. Chan, MD (Barrow Neurological Institute)	Dr. Chan has nothing to disclose.
Roy X. Zhang, MD (UT Houston Neurocritical Care)	No disclosure on file
Kenneth Griffin, MD (Intermountain Healthcare)	No disclosure on file
Amanda W. Fletcher, MD	Dr. Fletcher has nothing to disclose.
Robert S. Hamilton, MD	No disclosure on file
Steven Yuen, MD (Genentech, Inc.)	No disclosure on file
Joseph T. Duong, MD (Franciscan Medical Group)	No disclosure on file
Michael F. Waters, MD, PhD, F�鶹��ýӳ�� (Mount Sinai Scholl of Medicine)	Dr. Waters has nothing to disclose.

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