What is the fastest way to achieve therapeutic levels of heparin in the treatment of acute deep venous thrombi?
a. Continuous drip system
b. Follow established nomogram
c. Large bolus at 10 µg/kg
d. IV injections while tracking blood levels
ANS: B
The fastest way to achieve a therapeutic heparin effect is to follow an established nomogram. Several nomograms are currently available, and one is given in Table 28-6. These nomograms have been well accepted by clinicians and have led to aggressive heparin dosing and improve-ment in intermediate outcome. The use of nomograms has been associated with decreasing time to achieve therapeutic activated thromboplastin time (85% to 90% of patients achieve a therapeu-tic level within 24 hr) and a decrease in the variance of these parameters without any changes in bleeding rate.
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