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To study the effectiveness of a standard dose of unfractionated heparin in patients nSTEMI in a subgroup of elderly women and moderate chronic kidney disease at a delay of more than 12 hours of hospitalization.
Studied 306 patients nSTEMI, hospitalized within 12 hours, which were divided into 4 sub-group: patients ≥65 years (n=98) and women (n=79), patients with CKD stage 3 (n=84) and control group (under 65 years, men without CKD 3). All patients received infusion of unfractionated heparin recommended in the Guidelines scheme bolus is 4,000 units, followed by infusion of not more 1000U \ hour. Every 6 hours for 48 hours, the measured level of APTT. The target level was 2×normal range of aPTT
In the indicated dosages in the elderly for the first 18 hours you can not achieve the required numbers aPTT. In women, the first two indicators (12:00 heparin therapy) was significantly lower than control values (43,4±1,27 s., p=0.04 and from 42,1±2,02, p=0.009). Further indicators aPTT significantly improving and benchmarking. Subgroup renal disease is more difficult with the correct amount of APTT (APTT 1 - 41,0±2,53 s., p=0.03, aPTT 2 - 40,1±2,31 s., p=0.004, aPTT 3 - 44,8±2.14 s., p=0.02, aPTT 4 -51,4±1,11 s, p=0.03, aPTT 5 - 49,3±2,31 s, p=0.02. 6 and 7 shows the measurement data comparable to the control, but the eight measurement was again significantly less than control values. Results of the analysis indicate only about 50% of the patients included in the study, reach a therapeutic aPTT level in international schemes recommended dosage.
The proposed internationally recommended dose of UFH in patients with reduced GFR and the elderly, can not provide the required values of APTT in the early hours and did not reach the level of anticoagulation observed in the control group. With late hospitalization in these sub-groups must use higher doses of heparin, especially in the first 12 hours.