Clinical Factors which Affect the Amount and Length of Intravenous Heparin Infusion in Stroke

허혈성 뇌졸중환자의 헤파린 주입량과 주입기간에 영향을 미치는 임상적 요인

  • Choi, Ja-Yun (College of Nursing, Chonnam National University) ;
  • Kim, Mi-Won (College of Nursing, Chonnam National University)
  • 최자윤 (전남대학교 간호대학) ;
  • 김미원 (전남대학교 간호대학, 전남대학교 간호과학연구소)
  • Received : 2008.12.24
  • Accepted : 2009.05.22
  • Published : 2009.06.30

Abstract

Purpose: This study was conducted to examine the clinical factors which affected the amount and the duration of infusion of intravenous (IV) heparin on ischemic stroke. Method: A cross-sectional descriptive study was designed to examine the factors. A total of 101 patients with ischemic stroke from a University hospital in G-city, Korea from January to December, 2006 were participated in this study. Data were analyzed by t- and ANOVA test, correlation coefficient, and stepwise multiple linear regression analysis. Result: This study showed that the patients who have been temporarily stopped to infuse iv heparin for more than one hour, had cardioembolic stroke, and had the lower count of initial red blood cell (RBC) had significantly lower amount of iv heparin infusion per body surface. In addition, this study founded that the patients with lower count of initial RBC and the lower level of initial blood sugar were significantly less likely to have the lower length of iv heparin infusion. Conclusion: Continuous monitoring and controlling the count of RBC and the level of blood sugar are needed to increase the efficacy of iv heparin therapy on ischemic stroke. Further empirical studies should be conducted to support the results of this study.

Keywords

References

  1. Adams, H. P. Jr., Adams, R. J., Brott, T., del Zoppo, G. J., Furlan, A., Goldstein, L. B., Grubb, R. L., Higashida, R., Kidwell, C., Kwiatkowski, T. G., Marler, J. R., & Hademenos, G. J. (2003). Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association. Stroke, 34, 1056-1083. https://doi.org/10.1161/01.STR.0000064841.47697.22
  2. Adams, H. P. Jr., del Zoppo, G., Alberts, M. J., Bhatt, D. L., Brass, L., Furlan, A., Grubb, R. L., Higashida, R. T., Jauch, E. C., Kidwell, C., Lyden, P. D., Morgenstern, L. B., Qureshi, A. I., Rosenwasser, R. H., Scott, P. A., & Wijdicks, E. F. (2007). Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke, 38, 1655-1711. https://doi.org/10.1161/STROKEAHA.107.181486
  3. Al-Sadat, A., Sunbulli, M., & Chaturvedi, S. (2002). Use of intravenous heparin by North American neurologists: Do the data matter? Stroke, 33, 1574-1577. https://doi.org/10.1161/01.STR.0000018081.33541.E3
  4. Alvarez-Sabin, J., Molina, C. A., Ribo, M., Arenillas, J. F., Montaner, J., Huertas, R., Santamarina, E., & Rubiera, M. (2004). Impact of admission hyperglycemia on stroke outcome after thrombolysis: Risk stratification in relation to time to reperfusion. Stroke, 35, 2493-2498. https://doi.org/10.1161/01.STR.0000143728.45516.c6
  5. Bruno, A., Levine, S. R., Frankel, M. R., Brott, T. G., Lin, Y., Tilley, B. C., Lyden, P. D., Broderick, J. P., Kwiatkowski, T. G., & Fineberg, S. E. (2002). Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology, 59, 669-674. https://doi.org/10.1212/WNL.59.5.669
  6. Cohen, R. A. (2004). ATVB in focus: Diabetic vascular disease: Pathophysiological mechanisms in the diabetic milieu and therapeutic implications. Arterioscler Thromb Vasc Biol, 24, 1340-1341. https://doi.org/10.1161/01.ATV.0000137187.16206.79
  7. Cruickshank, M. K., Levine, M. N., Hirsh, J., Roberts, R., & Siguenza, M. (1991). A standard heparin nomogram for the management of heparin therapy. Arch Intern Med, 151, 333-337. https://doi.org/10.1001/archinte.151.2.333
  8. Ferroni, P., Basili, S., Falco, A., & Davi, G. (2004). Platelet activation in type 2 diabetes mellitus. J Thromb Haemost, 2, 1282-1291. https://doi.org/10.1111/j.1538-7836.2004.00836.x
  9. Freedman, M. D. (1992). Pharmacodynamics, clinical indications, and adverse effects of heparin. J Clin Pharmacol, 32, 584-596. https://doi.org/10.1002/j.1552-4604.1992.tb05765.x
  10. Gonzalez-Conejero, R., Fernandez-Cadenas, I., Iniesta, J. A., Marti-Fabregas, J., Obach, V., Alvarez-Sabin, J., Vicente, V., Corral, J., & Montaner, J. (2006). Role of fibrinogen levels and factor XIII V34L polymorphism in thrombolytic therapy in stroke patients. Stroke, 37, 2288-2293. https://doi.org/10.1161/01.STR.0000236636.39235.4f
  11. Hansen, H. R., Wolfs, J. L., Bruggemann, L., Sommeijer, D. W., Bevers, E., Hauer, A. D., Kuiper, J., Spek, C. A., Spronk, H. M., Reitsma, P. H., & ten Cate, H. (2007). Hyperglycemia accelerates arterial thrombus formation and attenuates the antithrombotic response to endotoxin in mice. Blood Coagul Fibrinolysis, 18, 627-636. https://doi.org/10.1097/MBC.0b013e3282891ebd
  12. Hirsh, J., Dalen, J. E., Deykin, D., & Poller, L. (1992). Heparin: Mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest, 102(4 Suppl), 337S-351S. https://doi.org/10.1378/chest.102.4_Supplement.337S
  13. Laing, S. P., Swerdlow, A. J., Slater, S. D., Burden, A. C., Morris, A., Waugh, N. R., Gatling, W., Bingley, P. J., & Patterson, C. C. (2003). Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia, 46, 760-765. https://doi.org/10.1007/s00125-003-1116-6
  14. Lindley, R. I., Wardlaw, J. M., Sandercock, P. A., Rimdusid, P., Lewis, S. C., Signorini, D. F., & Ricci, S. (2004). Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction. J Stroke Cerebrovasc Dis, 13, 235-246. https://doi.org/10.1016/j.jstrokecerebrovasdis.2004.03.003
  15. Marin, F., Roldan, V., Gonzalez-Conejero, R., & Corral, J. (2005). Pharmacogenetics in cardiovascular antithrombotic therapy. Curr Med Chem Cardiovasc Hematol Agents, 3, 357-364. https://doi.org/10.2174/156801605774322346
  16. Paciaroni, M., Agnelli, G., Micheli, S., & Caso, V. (2007). Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: A meta-analysis of randomized controlled trials. Stroke, 38, 423-430. https://doi.org/10.1161/01.STR.0000254600.92975.1f
  17. Roden-Jullig, A., & Britton, M. (2000). Effectiveness of heparin treatment for progressing ischaemic stroke: Before and after study. J Int Med, 248, 287-291. https://doi.org/10.1046/j.1365-2796.2000.00727.x
  18. Sagesaka, T., Juen, H., & Kaibara, M. (2000). Anemia as a risk factor of hemorrhagic tendency during surgery. J Obstet Gynaecol Res, 26, 103-109. https://doi.org/10.1111/j.1447-0756.2000.tb01291.x
  19. Schmidt, W. P., Heuschmann, P., Taeger, D., Henningsen, H., Buecker-Nott, H. J., & Berger, K. (2004). Determinants of IV heparin treatment in patients with ischemic stroke. Neurology, 63, 2407-2409. https://doi.org/10.1212/01.WNL.0000147542.37657.2F
  20. Song, H. J., & Jang, S. H. (2001). Use of heparin nomogram in acute ischemic stroke patients. Ann Bull Bum-Suk Acad Sch Found, 5, 181-185.
  21. Stegenga, M. E., van der Crabben, S. N., Levi, M., de Vos, A. F., Tanck, M. W., Sauerwein, H. P., & van der Poll, T. (2006). Hyperglycemia stimulates coagulation, whereas hyperinsulinemia impairs fibrinolysis in healthy humans. Diabetes, 55, 1807-1812. https://doi.org/10.2337/db05-1543
  22. Sung, Y. H., Hwang, S. H., Yu, K. H., Lee, J. H., Min, Y. K., Cho, S. J., Chu, I. K., & Lee, B. C. (2003). Current usage pattern of intravenous heparin for acute ischemic stroke by neurologists in Korea. Korean J Stroke, 5, 151-156.
  23. Tassies, D. (2006). Pharmacogenetics of antithrombotic drugs. Curr Pharm Des, 12, 2425-2435. https://doi.org/10.2174/138161206777698963
  24. Toth, C., & Voll, C. (2002). Validation of a weight-based nomogram for the use of intravenous heparin in transient ischemic attack or stroke. Stroke, 33, 670-674. https://doi.org/10.1161/hs0302.104168
  25. Vaidyula, V. R., Rao, A. K., Mozzoli, M., Homko, C., Cheung, P., & Boden, G. (2006). Effects of hyperglycemia and hyperinsulinemia on circulating tissue factor procoagulant activity and platelet CD40 ligand. Diabetes, 55, 202-208. https://doi.org/10.2337/diabetes.55.01.06.db05-1026
  26. Valles, J., Santos, M. T., Aznar, J., Osa, A., Lago, A., Cosin, J., Sanchez, E., Broekman, M. J., & Marcus, A. J. (1998). Erythrocyte promotion of platelet reactivity decreases the effectiveness of aspirin as an antithrombotic therapeutic modality: The effect of low-dose aspirin is less than optimal in patients with vascular disease due to prothrombotic effects of erythrocytes on platelet reactivity. Circulation, 97, 350- 355. https://doi.org/10.1161/01.CIR.97.4.350
  27. Yoon, S. S., Heo, S. H., Park, K. J., Chang, H. J., Ahn, T. B., Chang, D. I., Chung, K. C., & Kwon, Y. D. (2005). The usage of intravenous heparin in acute ischemic stroke in 10 teaching hospitals. J Korean Neurol Assoc, 23, 446-450.