Transcription of Anticoagulation in the Cardiac Catheterization …
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Anticoagulation in the Cardiac Catheterization …
Anticoagulation in the Cardiac Anticoagulation in the Cardiac Catheterization LaboratoryCatheterization LaboratoryJonathan D. Marmur, MD, FACCP rofessor of MedicineDirector, Cardiac Catheterization and Interventional CardiologyHealth Science Center at BrooklynState University of New YorkLimitations of HeparinLimitations of HeparinLimitationConsequenceNon-specific binding to plasma proteins and endothelial cellsVariability in anticoagulant effect, especially in seriously ill patientsRelease of Platelet factor 4 and vWFfrom platelets during clottingResults in heparin resistance and a need for higher levels of heparinInability of heparin to inactivate fibrin-bound thrombinThrombin remains active when bound to fibrin and continues to activate plateletsHeparin induces platelet activationHeparin induces platelet activationFurther activates the clotting cascade Further activates the clotting cascade and release of heparinand release of heparin--binding proteinsbinding pr
y = 89x + 32 y = 37x + 96 100 150 200 250 300 350 400 ACT (sec) UFH LMWH 175 Conversion of UFH targets of 200 and 300 sec (with and without adjunctive IIb/IIIa) to
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