If streptokinase (SK) or anistreplase (APSAC) is used, heparin should be given only in those patients who are at high risk for systemic emboli (. large anterior MI, atrial fibrillation, previous embolus, or known LV thrombus) (See standard dosage). Heparin should not be given <= 4 hours after fibrinolytic therapy and should be given when the aPTT is < 70 (goal aPTT 50—70 seconds). After 48 hours, consideration may be given to subcutaneous heparin administration (initial dose about 17,500 Units every 12 hours to maintain aPTT —2 times control), LMWH, or oral anticoagulants. If the patient has no risk factors and SK or APSAC is the thrombolytic that was used, therapeutic heparin is not recommended.
Hippocrates described a syndrome of wasting and progressive inanition among patients who were ill and dying. Derived from the Greek words kakos, meaning “bad things,” and hexus, meaning “state of being,” the term cachexia has been used to describe weight loss. From an, meaning “without,” and orexis, meaning “appetite, desire,” the word anorexia is used to characterize loss of appetite. Cachexia, a hypercatabolic state that is defined by an accelerated loss of skeletal muscle in the context of a chronic inflammatory response, is best described in the setting of cancer but is also seen in other advanced chronic illnesses including AIDS, heart failure, and chronic obstructive pulmonary disease (COPD) [ 1 ]. Although body composition changes are not identical in all of these disease states, the term cachexia is used in all of these settings.