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Does anyone have any resource they could direct me to to learn how to calculate this ? I dont like doing what the surgeon tells me without knowing how to do it myself :-/
Heparin Dosing For Carotid Endarterectomy
- Thread starter divinemsm
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I doubt you will find anything. Every surgeon is different. Most probably want somewhere in the neighborhood of 5000 units. I've seen anywhere from 3000-7000 for the most part. Some will actually want an ACT to be measured and around 200-220.
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You can do it yourself- just make up a number like the surgeon does, and tell everyone about your anecdotal experience leading you to the derived value.
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Our peeps like the ACT 1.5-2x (closer to 2x) the baseline value. They always ask the pt's weight prior to dosing, but usually ask for the same dose. Unless they are really obese, 5000 units usually gets them to the desired value for a while.
TM
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Our vascular surgeons typically ask for 100 units/kg
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No no no. The correct number is always located deep in the attending surgeon's rectum.
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There is only one publication that I could find that speaks to fixed vs weight based dosing in carotid endarterectomy:
Safety and efficacy of fixed-dose heparin in carotid endarterectomy. Poisik A, Heyer EJ, Solomon RA, Quest DO, Adams DC, Baldasserini CM, McMahon DJ, Huang J, Kim LJ, Choudhri TF, Connolly ES. Neurosurgery. 1999 Sep;45(3):434-41; discussion 441-2.
That article is available here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777760/?tool=pubmed
Fixed dosing would be 5000 units.
For weight based dosing, the above study used 85 units/kg. Most standard hospital nomograms will be for 80 units/kg. Systemic heparinization doses typically range from 50-100 units/kg. Right now, most references list 75 or 80 units/kg as a standard dose. 100 units/kg would be fair. So would 50 units/kg for an adult up to 100kg, per the article above - for now.
The reformulated heparin with 10% less potency should be hitting the market in some places right about now. Dosing strategies will likely be affected, especially for procedures requiring aggressive systemic heparinization.
Safety and efficacy of fixed-dose heparin in carotid endarterectomy. Poisik A, Heyer EJ, Solomon RA, Quest DO, Adams DC, Baldasserini CM, McMahon DJ, Huang J, Kim LJ, Choudhri TF, Connolly ES. Neurosurgery. 1999 Sep;45(3):434-41; discussion 441-2.
That article is available here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777760/?tool=pubmed
Fixed dosing would be 5000 units.
For weight based dosing, the above study used 85 units/kg. Most standard hospital nomograms will be for 80 units/kg. Systemic heparinization doses typically range from 50-100 units/kg. Right now, most references list 75 or 80 units/kg as a standard dose. 100 units/kg would be fair. So would 50 units/kg for an adult up to 100kg, per the article above - for now.
The reformulated heparin with 10% less potency should be hitting the market in some places right about now. Dosing strategies will likely be affected, especially for procedures requiring aggressive systemic heparinization.
