Shortened hospitalization by means of adjusted-dose subcutaneous heparin for deep venous thrombosis.
Shortened hospitalization by means of adjusted-dose subcutaneous heparin for deep venous thrombosis.
复制标题
通过调整剂量皮下注射肝素治疗深静脉血栓，缩短住院时间。
DOI：
10.1016/s0002-8703(96)90354-3
复制
发表时间：
1996
影响因子：
4.8
通讯作者：
Goldhaber,SZ
中科院分区：
文献类型：
--
作者：
Hirsch,DR;Lee,TH;Morrison,RB;Carlson,W;Goldhaber,SZ
调整剂量皮下普通肝素（SC肝素）用于深静脉血栓形成（DVT）的初始管理，以缩短住院时间。在筛选的78例患者中，41%合格，18例（23%）入组。出院后6周进行随访静脉超声检查。在入组的患者中，16例（89%）完成了方案。方案患者的住院时间为2天，而接受常规住院肝素持续静脉输注的患者为5天（p = 0.0009）。最初需要非常高的肝素剂量（平均42，000至62，000 U/天，每8小时分三次给药）和21小时的中位时间才能达到目标活化部分凝血活酶时间（aPTT）>55秒。随后，许多患者达到了超治疗水平，但没有出血并发症。4名患者（25%）在随访超声时未显示改善，尽管第二次注射后aPTT>55秒。其余患者的血凝块消退明显。住院费用的节省部分被出院后需要进行时间和劳力密集的门诊监测所抵消。
Adjusted-dose subcutaneous unfractionated heparin (SC heparin) was used in the initial management of deep venous thrombosis (DVT) to allow shortened hospital stay. Of 78 patients screened, 41% were eligible and 18 (23%) were enrolled. Follow-up venous ultrasound examination was performed 6 weeks after discharge. Of enrolled patients, 16 (89%) completed the protocol. Hospital length of stay was 2 days in protocol patients compared with 5 days for patients receiving conventional inpatient heparin with a continuous intravenous infusion (p = 0.0009). Very high heparin doses (mean 42,000 to 62,000 U dally, given in three divided doses every 8 hours) and a median time of 21 hours were required initially to achieve a target activated partial thromboplastin time (aPTT) >55 seconds. Subsequently many patients had supratherapeutic levels, yet there were no bleeding complications. Four patients (25%) did not show improvement at follow-up ultrasound in spite of aPTTs >55 seconds after the second injection. Clot regression was evident in remaining patients. Hospital cost savings were offset partially by the need for time- and labor-intensive outpatient monitoring after hospital discharge.