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The rate of major spontaneous hemorrhage for both heparin and hirudin in RIMI 9A was higher than that seen in TIMI 5,TIMI 6,and GUSTO 1.This was possibly a result of high levels of anticoagulation at the doses of heparin and hirudin used,low previous estimates of the hemorrhage risk at the doses of hirudin used in TIMI 9A due to the relatively small number of patients receiving that dose in earlier studies,and enrollment of patients at higher risk of hemorrhage.Because a prolonged aPTT was associated with an increased risk of major hemorrhage in both heparin-and hirudin-treated patients,it now appears important to monitor aPTT on a regular basis when using either antithrombin to identify those patients who require downward adjustment of the infusion.TIMI 9B has therefore been configured with a lower hirudin bolos(0.1 mg/kg)and infusion(0.1 mg/kg per hour)and lower heparin infusion(1000 U/h without weight adjustment).Infusions of both antithrombins will be titrated to a target aPTT of 55 to 85 seconds. |
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adverse drug reaction
anticoagulant,complications of
anticoagulant,treatment
fibrinolytic agents
fibrinolytic agents,complications
heparin
hirudin
iatrogenic neurologic disorders
intracerebral hemorrhage
intracranial hemorrhage
myocardial infarction
myocardial infarction,acute
partial thromboplastin time,prolonged
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