Method to calculate the protamine dose necessary for reversal of heparin as a function of activated clotting time in patients undergoing cardiac surgery.

Activated clotting time (ACT) has been used to monitor coagulation and guide management of anticoagulation control in patients undergoing cardiac surgery for decades. However, reversal of heparin with protamine is typically empirically based on total heparin administered. Dose-related adverse effects of protamine are well described. The aim of this study was to evaluate a heparin reversal strategy based on calculation of the protamine dose based on ACT measurements. We present a method using a mathematical formula based on the dose-response line (1). To check the formula, we performed a retrospective observational cohort study of 177 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The study group of 80 patients was administered the dose of protamine obtained using our formula, and the control group of 97 patients was administered the empirically calculated dose. The ACT returned to normal values in patients who were given doses of protamine that were calculated using our formula; all but two had a final ACT of 141. The application of the formula resulted in a significant reduction in the dose of protamine (p < .023). The formula we present is a valid method for calculating the dose of protamine necessary to neutralize heparin. This same method can be used working with a target ACT to adjust the dose of heparin. As a result of its functionality, it allows application on a daily basis standardizing the process. We believe that the formula we developed can be applied in all those procedures in which it is necessary to anticoagulate patients with heparin and later neutralization (cardiac surgery with or without CPB, vascular surgery, procedures of interventional cardiology, and extracorporeal depuration procedures).

Hemorragia intracerebral lobular: análisis de una serie y características en pacientes antiagregados y anticoagulados / Lobar intracerebral haemorrhage: analysis of a series and characteristics of patients receiving anti-platelet or anticoagulation treatment

Introducción: La hemorragia intracerebral lobular (HIL) es una causa poco frecuente de ictus y representan cerca del 20% de las hemorragias intracerebrales primarias. La causa más frecuente son la angiopatía amiloidea cerebral (AAC), la hipertensión arterial (HTA) y otras como el tratamiento antiagregante o anticoagulante. Analizar una serie de pacientes con HIL y compararla con subgrupos de pacientes con HIL antiagregados o anticoagulados previamente. Determinar el volumen de la hemorragia y su valor predictivo de mortalidad.Pacientes y métodos: Se incluyó de forma consecutiva y retrospectiva a 162 pacientes diagnosticados de HIL y atendidos en el servicio de neurología del Hospital Meixoeiro de Vigo entre los años 1991 y 2009. Se recogieron características demográficas, factores de riesgo, etiologías y clínica, y se realizó un análisis comparativo entre la serie general y los subgrupos de paciente antiagregados y anticoagulados.Resultados: En la serie general la causa más frecuente fue la AAC posible o probable seguida de la HTA. En los subgrupos de pacientes antiagregados o anticoagulados no había diferencias en las variables estudiadas excepto en la frecuencia de cardiopatía. Sí existían diferencias en cuanto a la edad, la cardiopatía y la volumen de la hemorragia entre la serie general (sin los pacientes antiagregados o anticoagulados) cuando se compararon con los subgrupos de antiagregados y anticoagulados.Conclusiones: Aportamos algunas novedades respecto al comportamiento clínico de la HIL y sus diferencias en los pacientes antiagregados o anticoagulados. La mortalidad es superior en las HIL anticoaguladas. Son variables predictivas de defunción el sexo femenino y el volumen de la hemorragia (AU)

Introduction: Lobar intracerebral haemorrhage (LIH), is a rare cause of stroke which accounts for about 20% of primary intracerebral haemorrhages. The most common causes are cerebral amyloid angiopathy (CAA), high blood pressure and others, such as using anti-platelet or anticoagulation agents. We analysed a series of patients with LIH and compared it with subgroups of patients with LIH who were previously receiving anti-platelet or anticoagulation agents. We determined the volume of the bleeding and its predictive value for mortality. Patients and methods: We consecutively and retrospectively included 162 patients diagnosed with LIH and cared for in the Neurology Department of Hospital Meixoeiro in Vigo between 1991 and 2009. We collected demographic characteristics, risk factors, aetiologies and symptoms, and conducted a comparative analysis between the general series and the subgroups of patients receiving anticoagulation and anti-platelet agents. Results: In the general series, the most common cause was possible or probable CAA followed by hypertension. In the subgroup of patients receiving anti-platelet or anticoagulation agents there were no differences in the variables studied, except for the frequency of heart disease. Nonetheless, there were differences with respect to age, heart disease and bleeding volume between the general series (patients not treated with anti-platelet or anticoagulation agents) when compared with the subgroups of patients receiving anti-platelet and anticoagulation agents. Conclusions: We provide new information regarding the clinical behaviour of LIH and its differences in patients receiving anti-platelet or anticoagulation agents. Mortality is higher in cases of LIH on anticoagulants. LIH. Female sex and the volume of bleeding are predictors of mortality (AU)

Lobar intracerebral haemorrhage: analysis of a series and characteristics of patients receiving antiplatelet or anticoagulation treatment.

INTRODUCTION: Lobar intracerebral haemorrhage (LIH), is a rare cause of stroke which accounts for about 20% of primary intracerebral haemorrhages. The most common causes are cerebral amyloid angiopathy (CAA), high blood pressure and others, such as using anti-platelet or anticoagulation agents. We analysed a series of patients with LIH and compared it with subgroups of patients with LIH who were previously receiving anti-platelet or anticoagulation agents. We determined the volume of the bleeding and its predictive value for mortality. PATIENTS AND METHODS: We consecutively and retrospectively included 162 patients diagnosed with LIH and cared for in the Neurology Department of Hospital Meixoeiro in Vigo between 1991 and 2009. We collected demographic characteristics, risk factors, aetiologies and symptoms, and conducted a comparative analysis between the general series and the subgroups of patients receiving anticoagulation and anti-platelet agents. RESULTS: In the general series, the most common cause was possible or probable CAA followed by hypertension. In the subgroup of patients receiving anti-platelet or anticoagulation agents there were no differences in the variables studied, except for the frequency of heart disease. Nonetheless, there were differences with respect to age, heart disease and bleeding volume between the general series (patients not treated with anti-platelet or anticoagulation agents) when compared with the subgroups of patients receiving anti-platelet and anticoagulation agents. CONCLUSIONS: We provide new information regarding the clinical behaviour of LIH and its differences in patients receiving anti-platelet or anticoagulation agents. Mortality is higher in cases of LIH on anticoagulants. LIH. Female sex and the volume of bleeding are predictors of mortality.

[Lobar intracerebral haemorrhage and cerebral amyloid angiopathy: analysis of a series of 106 patients]. / Hemorragia intracerebral lobular y angiopatía amiloidea cerebral: análisis de una serie de 106 pacientes.

INTRODUCTION: Lobar intracerebral haemorrhage (LH) is an uncommon cause of stroke. Many LH are caused by cerebral amyloid angiopathy (CAA). The aim of the present study is to analyse the clinical signs, risk factors, lesion volume and development, of a consecutive series of patients suffering from LH and to compare the various characteristics between haemorrhages which comply with the Boston criteria for CAA and those which do not comply with these inclusion criteria. METHODS: A consecutive series of 106 patients suffering from LH and admitted to the neurological service in the Meixoeiro Hospital of Vigo between 1991 and 2005 is described. The Boston criteria were applied to all patients suffering from LH associated with possible, probable and confirmed CAA. The clinical signs, risk factors, haemorrhage sizes, evolution and complications of the patients complying with the CAA inclusion criteria were compared to those who did not comply with the inclusion criteria. RESULTS: The 106 patients from the series, represent 14.4% of intracerebral haemorrhages and 3.7% of all strokes. Fifty-four percent (54 %) of the patients were female and arterial hypertension was an important risk factor. Twenty point eight percent (20.8%) of the patients were admitted in coma and 60% with hemiparesis. Of these LH patients 28.3% died. The haemorrhage volume and the female gender were the only predictive factors for death. No significant variables were observed to differentiate the groups in the comparative analysis of the subgroups of patients with CAA inclusion criteria and those without. CONCLUSIONS: The series studied showed similar risk factors and clinical characteristics to other published series. No predictive clinical variables were found to differentiate between LH which complied with CAA inclusion criteria and those that did not comply.