Method for Intravenous Administration of Heparin in Myocardial Infarction

Harden, R. McG.

doi:10.1136/bmj.2.5365.1106

Cited by 7 publications

(2 citation statements)

References 7 publications

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“…One is therefore faced with the need for repeated injections evenly spaced at threeor fourhour intervals both by day and night, if extreme changes in clotting time and therefore possibly of anticoagulant effect, are to be avoided. An acceptable alternative supported by Harden (1963) is the administration of heparin by intravenous infusion. Even accepting that without the use of a constant infusion device the rate of delivery of heparin given by gravity drip infusion will vary, it should be possible to ensure continuous action throughout the 24 hours and to monitor the effect by laboratory tests.…”

Section: Discussionmentioning

confidence: 99%

Laboratory control of heparin therapy

O’Shea¹,

Flute²,

Pannell³

1971

J Clin Pathol

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SYNOPSISThe effect of heparin therapy was followed in 50 patients treated for thrombo-embolic disease. Individual response to a standard dose of 40,000 units of heparin daily showed a considerable variation and the effect was not constant on subsequent days. Five of the 50 patients developed a serious haemorrhage.It is proposed that to ensure the adequacy of treatment detectable levels of heparin should be obtained but because of the high risk of bleeding these levels should not be excessive.The results suggest that control of heparin therapy can be based on the thrombin clotting time. Using this test it is advised that treatment is monitored daily in order to achieve a plasma heparin level of up to 1 mg per 100 ml. Classical laboratory control is with the whole blood clotting time. It is often said that this should be prolonged to between one and a half and three and a half times the normal value for the individual. On intermittent intravenous injection the test should be taken just before the next dose is due. It is not clear whether the same criteria should be used for continuous heparin infusion. The clotting time is imprecise, difficult to standardize, and if any degree of accuracy is to be obtained the test must be performed at the bedside and at 37°C. Few will be content to wait the long time till the endpoint is reached. Since heparin inhibits the action of thrombin many of the standard clotting tests should be affected. Some of these were first examined for their sensitivity to the effect of heparin added to normal plasma. Blood from a series of 50 patients who were receiving heparin infusions was then examined to test these laboratory findings in practice.

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Section: Discussionmentioning

confidence: 99%

Laboratory control of heparin therapy

O’Shea¹,

Flute²,

Pannell³

1971

J Clin Pathol

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“…Both had an important influence on my career and each, in their own way, served as a powerful role‐model. As a house officer, with the encouragement of senior staff, I was able to undertake studies and publish papers including the first description of the continuous intravenous use of heparin in patients with myocardial infarction, 3 a record of the inaccuracies of the thermometers used to measure the temperature of patients in the ward 4 and an account of the sequence of events when a patient broke a thermometer in his mouth and swallowed the end containing mercury 4 . I still remember the thrill when, having developed a method of measuring the iodide concentration in sweat, I realised that I was the first in the world to know the concentration levels and the mechanism of excretion – not a momentous or practical discovery, but one that was hugely satisfying personally 5…”

Section: Phase 1: 1960–1972 Developing An Interest In Medical Educatmentioning

confidence: 99%

Looking back to the future: a message for a new generation of medical educators

Harden

2011

Medical Education

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The following lessons have been learned. (i) People are important as role models and collaborators. (ii) Innovation in medical education is a complex process and research findings can easily be misinterpreted. (iii) Nudges, interventions that encourage rather than mandate change, are valuable. (iv) Students are important players in planning, delivering and evaluating a curriculum. Each student has different needs and aspirations. They are the 'digital natives'. (v) Offer stakeholders practical solutions to problems that can be implemented. (vi) There is always something to learn outside one's own practice. Go to a conference or read a journal in a related field. (vii) Time spent recording one's work and publishing reports based on it is rewarding. (viii) Learn from history. We don't need to keep reinventing the wheel. (ix) Obtain independent funding. (x) Finally, and most importantly, have fun. Working in medical education can be exciting, fulfilling and hugely enjoyable.

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Heparin for Thromboembolic Disease

Handley

1966

The Lancet

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Method for Intravenous Administration of Heparin in Myocardial Infarction

Cited by 7 publications

References 7 publications

Laboratory control of heparin therapy

Laboratory control of heparin therapy

Looking back to the future: a message for a new generation of medical educators

Heparin for Thromboembolic Disease

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