Comparison Study of heparin injection by using intermittent intravenous injection and Continuous Infusion Syringe Pump , on APTT results and possible side effects in patients with acute coronary syndrome (ACS), in 22 Bahman Hospital of Neishabour

Comparison Study of heparin injection by using intermittent intravenous injection and Continuous Infusion Syringe Pump , on APTT results and possible side effects in patients with acute coronary syndrome (ACS), in 22 Bahman Hospital of Nishabour

This research is done as a clinical trial with random allocation with permutation blocks. 2. Research population: All patients have selected based of diagnosis of ACS at 22 Bahman Neishabur Hospital with age of 50 to 75 years old. Patients are divided into two equal groups of 30 people, and in one group, heparin has been injected as an intermittent intravenous every 3 hours at 2500 units, and every 6 hours the sample is sent to control the APTT. If APTT is greater than 100 seconds, one dose will not be injected, but subsequent doses will be repeated in the same way, and the APTT will be controlled repeatedly. In the second group, heparin is injected by using Continuous Infusion Syringe Pump, in the first step, 5000 units are initially injected into a venous block, and then 12 units per kilogram per hour (about 1000 units per hour) are injected by Infusion and APTT is controlled at every 6 hours. If APTT was more than 100 seconds, for one hour infusion interrupted and then it continues again. In both ways, for 48 hours after the start of the test, the APTT test is performed every 6 hours and information is recorded in the patient's APTT examination checklist. Each patient was assigned a code number.

This research has been done by considering Ethical considerations and after obtaining permission from the ethics committee of Sabzevar University of Medical Sciences and receiving a letter of introduction to the 22 Bahman Neishabur Hospital and obtaining permission from the hospital authorities and the consent of the patients. The clinical trial have been done on patients with age of 50 to 75 years old with acute coronary syndrome, which includes STEMI-NONSTEMI and unstable angina. . These diagnostics (ACS) are approved by cardiologists. This study was performed after selecting patients with acceptance and not acceptance in CCU1 and CCU2 sections of Neishabour’s 22 Bahman Hospital in 2018. In this study, after the demographic data was recorded the data were recorded as a primary sample other than PTT, PT and INR, the CBC exam is also checked for possible complications (as mentioned in the statement). Patients by using random allocation and permutation blocks, according to the statistical calculation are divided into two equal groups of 30 people, and in one group of patients, heparin is given as an intermittent intravenous injection every 3 hours at 2500 units, and every 6 hours the sample is sent to control the APTT. If APTT is greater than 100 seconds, a dose will not be given, but subsequent doses will be repeated in the same way, and the APTT will be controlled repeatedly. In the second group, infusion pump with syringe pump, 60 units (about 5000 units) are initially injected into a venous block, and then 12 units per kilogram per hour (about 1000 units per hour) are infused continuously and every 6 hours APTT is controlled. If the APTT lasts more than 100 seconds, it will be interrupted for an hour and then will resume again. In both ways, for 48 hours after the start of the test, the APTT test is performed every 6 hours and information is recorded in the patient's APTT examination checklist. (preparation of blood sample for PTT is such that 1.8 cc of the patient's blood in a special tube containing 0.2 cc citrate after placing the lid several times in the palm of your hand, Shake until blood is mixed with citrate inside the tube and then sent to the lab), and in the alternate injection method, heparin is diluted with at least two cc distilled water at a time to minimize the amount of drug in the angioket route. Both methods are checked four times daily in the APTT. APTT should be 1.5 to 2.5 times the normal range, that is, about 50 to 70 seconds. Then, the obtained results are compared and evaluated according to the criteria of entry and exit. Possible complications associated with heparin (such as hemorrhagic hemorrhage, hematuria, gingival bleeding, blood or vomiting, melena, constipation, cerebral hemorrhage due to reduced consciousness and neurological symptoms, thrombocytopenia, and allergic reactions.

The clinical trial is on patients with age of 50 to 75 years old with acute coronary syndrome, which includes STEMI-NONSTEMI and unstable angina. – inclusion criteria: 1.Acute coronary syndrome upon to the cardiologist's diagnosis. 2.Informed consent for participation in the study. 3. Age in the range of 50 to 70. – Non- acceptance. 4. History of inaccessible bleeding ulcers especially in the gastrointestinal tract, according to the patient's history and previous endoscopy; 5. Active bleeding associated with blood dislocation or tendency to bleed like hemophilia thrombocytopenia; blood cancer; 6 - liver disease leading to coagulation disorders; 7. Presence of suspected intracranial hemorrhage; 8. Presence of thrombophlebitis 9 - presence of wounded or wounded injuries Skin 10. Subacute Endocarditis 11.Existing Renal failure 12 - Excessive Blood Pressure 160 Over 90 Resistant to Treatment 13. Eye or Spinal Cord Operations in Recent Months 14. INR more than 3/5 and the platelets below 100,000 /l 15. Having APTT in excess of 100 Exclusion criteria during research: 1. Dissatisfaction of patient or withdrawal from continuing research or discharging sooner or with personal satisfaction. 2. If the patient experiences complications during the study, such as thrombocytopenia, hemoglobin and hematocrit, gastrointestinal bleeding or allergic reactions. 3. Excessive extent of APTT (more than 2.5 times of normal range) and its consistence after reducing the injected dose. 4. Decrease of Hemoglobin more than 2 mg / dl after injecting heparin.

The clinical trial on patients with age of 50 to 75 years old with acute coronary syndrome, which includes STEMI-NONSTEMI and unstable angina.

1-The activated partial thromboplastin time (APTT) 2.Intermittent intravenous injection of heparin 3- continuous infusion of heparin

Sabzevar University of Medical Sciences and personal expenses

In this study, limited randomization was used randomly and the subjects were divided in two equal groups. The first 30 person who were diagnosed with ACS were placed in the continuous infusion group and the next 30 who were admitted to this diagnosis were placed in intermittent intravenous injection.