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Abstract Details

Characterization of Unfractionated Heparin Infusions in a Comprehensive Stroke Center
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (12:00 PM-1:00 PM)
Stroke patients with arterial or venous intraluminal thrombus (ILT) are at high risk of stroke recurrence and embolic or hemorrhagic complications. Treatment with anticoagulation remains challenging due to onset of action, efficacy, and risk of hemorrhage. Unfractionated heparin (UFH) has been used due to its short half-life in the context of risk of hemorrhagic transformation of the infarct zone. Heparin nomograms and associated bolus dosing are not standardized in clinical practice, can exhibit long epochs of time under or over the therapeutic PTT range. This results in suboptimal protection and added risk of hemorrhage respectively.

We aim to characterize the use and efficacy of heparin infusion in cerebrovascular conditions at a large academic comprehensive stroke center.

A retrospective analysis from 2016 to 2019 was conducted at Sunnybrook Health Sciences on adult patients in either critical care or stroke units with UFH infusion. We classified infusions based on indication type, and computed percentage of PTT values under the target, at target, or above target PTT values. Where possible, we also correlated with clinical parameters and imaging findings. In addition the agent that patients were switched to was also tracked.
Approximately 15% of patients had no measurements in the therapeutic range. A minority of patients had all their values in the therapeutic range, and some spent the bulk of their measurements in the supra-therapeutic range. The median percentage of PTT measurements above therapeutic range was approximately 57% with a similar percentage of patients having at least on supra-therapeutic value.
UFH infusion is used in stroke despite lack of clear evidence and efficacy. Intraluminal thrombus was the most common indication. A marked fraction of patients have PTT value either below or above therapeutic PTT ranges.  Supra-therapeutic values are common. Our study suggests use low-molecular weight heparin is a better alternative to UFH.
Tess Fitzpatrick, MD
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Houman Khosravani, MD, PhD (Sunnybrook Health Sciences Centre, University of Toronto) Dr. Khosravani has nothing to disclose.