TY - JOUR
T1 - Physicians' use of heparin following thrombolytic therapy
T2 - An international perspective
AU - Berdan, Lisa G.
AU - Kleiman, Neal S.
AU - Woodlief, Lynn H.
AU - Harrington, Robert A.
AU - Granger, Christopher B.
AU - Califf, Robert M.
N1 - Funding Information:
Supported by Genentech, South San Francisco, California; Research Grant HS-05635 from the Agency for Health Care Policy and Research, Rockville, Maryland, and Research Grants HL-36587 and NSRA 5732 HL07101-15 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland
Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1997
Y1 - 1997
N2 - Background: The current prevalence, timing, and route of heparin use after thrombolytic therapy for acute myocardial infarction both within and outside the United States (U.S.) have not been extensively studied. Method: An 18-item questionnaire was mailed to cardiologists and emergency medicine practitioners in the U.S. and to physicians in 5 countries considering participation in an international trial of thrombolytic therapy. Results: Almost all used some form of heparin after recombinant tissue-plasminogen activator; 8% withheld heparin after streptokinase. Non-U.S. physicians used subcutaneous heparin more frequently than did U.S. physicians (26% vs. 4%). Time to heparin initiation varied greatly. Most physicians used the activated partial thromboplastin time to monitor anticoagulation, although there was little consensus about the appropriate way to determine the efficacy of heparin therapy. Conclusions: This survey shows considerable disagreement about the preferred administration of heparin among physicians treating patients with myocardial infarction. This lack of agreement reflects uncertainty about how heparin therapy should be used. When the results of well-designed clinical trials examining the optimal dosing, timing, and monitoring of heparin therapy have been published, perhaps the clinical community can reach a consensus.
AB - Background: The current prevalence, timing, and route of heparin use after thrombolytic therapy for acute myocardial infarction both within and outside the United States (U.S.) have not been extensively studied. Method: An 18-item questionnaire was mailed to cardiologists and emergency medicine practitioners in the U.S. and to physicians in 5 countries considering participation in an international trial of thrombolytic therapy. Results: Almost all used some form of heparin after recombinant tissue-plasminogen activator; 8% withheld heparin after streptokinase. Non-U.S. physicians used subcutaneous heparin more frequently than did U.S. physicians (26% vs. 4%). Time to heparin initiation varied greatly. Most physicians used the activated partial thromboplastin time to monitor anticoagulation, although there was little consensus about the appropriate way to determine the efficacy of heparin therapy. Conclusions: This survey shows considerable disagreement about the preferred administration of heparin among physicians treating patients with myocardial infarction. This lack of agreement reflects uncertainty about how heparin therapy should be used. When the results of well-designed clinical trials examining the optimal dosing, timing, and monitoring of heparin therapy have been published, perhaps the clinical community can reach a consensus.
KW - Heparin
KW - Myocardial infarction
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=0030793732&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030793732&partnerID=8YFLogxK
U2 - 10.1023/A:1008805601821
DO - 10.1023/A:1008805601821
M3 - Article
AN - SCOPUS:0030793732
VL - 4
SP - 415
EP - 423
JO - Journal of Thrombosis and Thrombolysis
JF - Journal of Thrombosis and Thrombolysis
SN - 0929-5305
IS - 3-4
ER -