Audit of anticoagulation after embolectomy for acute ischaemia.
BACKGROUND
Intravenous unfractionated heparin (UFH) is routinely used in patients after arterial embolectomy. Achieving and maintaining therapeutic levels requires a co-ordinated approach which may be difficult for busy junior doctors and laboratories. There is no current evidence regarding the use of subcutaneous low molecular weight heparin (LMWH) as an alternative.


METHODS
The study retrospectively examined all patients who had undergone any form of embolectomy during 2006 and 2007 by review of their medical records, an electronic laboratory database, and the patients' drug charts.


RESULTS
Overall, 45 patients were studied. A total of 389 activated partial thromboplastin time (APTT) tests were performed of which 146 (37.6%) were in the therapeutic range (50-90 s), 40.4% were < 50 s and 22.1% were > 90 s. Five patients (11.1%) had further surgical procedures. Significant bleeding occurred in two patients.


CONCLUSIONS
The results indicate that many patients are not appropriately anticoagulated. Whilst a new UFH protocol is being developed by our hospital trust, the authors believe the use of LMWH could provide a more effective and user-friendly alternative to UFH.
Robinson
T
T
Department of Vascular Surgery, Oxford Radcliffe NHS Trust, Oxford, UK. tmrobinson@doctors.org.uk
Hunter
I
I
Wathes
R
R
Keeling
D
D
Hands
L
L
D000208:Acute Disease; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D017128:Embolectomy / Q000379:methods*; D004617:Embolism / Q000188:drug therapy*; D006470:Hemorrhage / Q000188:drug therapy; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D055104:Infusions, Subcutaneous; D010314:Partial Thromboplastin Time; D012189:Retrospective Studies
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight