Feasibility Study of Unfractionated Heparin in Acute Chest Syndrome
Acute Chest Syndrome, Sickle Cell Disease
About this trial
This is an interventional treatment trial for Acute Chest Syndrome focused on measuring Sickle cell disease, Acute chest syndrome, Hemoglobinopathy, Hemolytic anemia, Heparin, Anticoagulant
Eligibility Criteria
Inclusion Criteria:
- Diagnosis of ACS defined as a new pulmonary infiltrate involving at least one segment of the lung on a chest x-ray or chest CT scan with 2 or more of the following: chest pain, tachypnea, dyspnea, cough, hypoxemia, or body temperature greater than or equal to 38.0 degrees Celsius
- Hemoglobin electrophoresis confirming HbSS, SC, or B0 (historical records sufficient)
- Age greater than or equal to 18
Exclusion Criteria:
- Any absolute contraindication to heparin
- Platelet count less than 50 per microliter (current admission)
- Historical diagnosis of moyamoya disease as documented in medical records
- Historical diagnosis of proliferative retinopathy as documented in medical records
- Current participation in a chronic exchange transfusion program
- Underlying hypercoagulable disorder other than sickle cell disease
- Currently receiving therappeutic anticoagulation
- Currently receiving antiplatelet agents
- Currently receiving estrogen containing oral contraceptives
- Chest CT scan documented PE performed as standard of care prior to study enrollment (current admission)
Sites / Locations
- University of Pittsburg Medical Center
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Unfractionated heparin
Standard of care
Subjects will be randomized within 24 hours of diagnosis to one of two treatment arms, Arm A, anticoagulation and standard of care, or Arm B, no anticoagulation and standard of care. Weight-adjusted UFH will be given at doses of 80 units per kilogram followed by 18 units per kilogram per hour intravenously for 7 days, or until discharge, if discharge is shorter than 7 days. UFH will be monitored by standard protocol to maintain the activated partial thromboplastin time in the therapeutic range per institutional guidelines. The experimental arm will receive standard of care, too, which will include the following: intravenous fluids, antibiotics, supplemental oxygen, incentive spirometry, pain management, red blood cell transfusions, and exchange transfusions.
Standard care will include the following: intravenous fluids, antibiotics, supplemental oxygen, incentive spirometry, pain management, red blood cell transfusions, and exchange transfusions.