Heparin Flush Research Articles

Validação da Morse Fall Scale – versão brasileira para pessoas idosas institucionalizadas (MFS-B/ILPI)

Abstract Objective To validate the criterion and construct of the Morse Fall Scale - Brazilian version (MFS-B) for institutionalized older adults. Method Methodological validation study nested within a longitudinal study. The research was conducted in two Homes for the Aged (ILPIs), involving 172 older individuals. Data were collected through direct assessment of the older adult and chart data. Analysis was performed using descriptive and inferential statistics including ROC curve, sensitivity, specificity, Pearson correlation, and Exploratory and Confirmatory Factor Analysis. Results The best estimate for predicting falls was at the cutoff point of 45 points on the MFS-B for institutionalized older adults, with a sensitivity of 93.3% and specificity of 58.9%. When analyzing the reliability of the MFS-B with the exclusion of the item "intravenous therapy/saline or heparin flush catheter" – "IV therapy/SHFC” reliability improved (α≥0.700), and this exclusion was also supported by Exploratory and Confirmatory Factor Analysis. Conclusions The results indicate a good predictive ability of the MFS-B for institutionalized older adults, with improved accuracy when excluding the item "IV therapy/SHFC". These findings supported the adaptation of the MFS-B to five assessment items, referred to as MFS-B/ ILPI.

Effect of intra-arterial heparin flushing (IAHF) to prestin and vascular endothelial growth factor (VEGF) level in hearing loss patients

Background: According to the World Health Organization (WHO), hearing loss is the fourth largest disability globally, affecting an estimated 466 million people in 2018. In Indonesia, the prevalence of hearing loss was estimated at 16.8% in 2016. Intra-Arterial Heparin Flushing (IAHF) is an endovascular technique that uses heparin to promote reperfusion and increases Vascular Endothelial Growth Factor (VEGF) expression. VEGF is a polypeptide angiogenesis factor present in the nervous system, which functions as a neurotrophic and neuroprotective. Meanwhile, prestin is a protein of outer ear hair cells that shows early signs of hearing loss through increased levels in cases of ear hair cell damage. Objective: This study aims to evaluate the effect of IAHF on prestin and VEGF levels in hearing-impaired patients. Methods: The design is experimental with Pre-Post Test One-Group Only. A total of 22 patients with hearing loss were measured for prestin and VEGF before and 4 hours after the IAHF procedure. Results: The results of the Wilcoxon test showed no significant differences in prestin level (p=0.658) and VEGF level (p=0.291) before and after the IAHF procedure. The mean showed an insignificant decrease in prestin level before and after the IAHF procedure with values of 1,185+1,229 pg/mL and 1,096+1,183 pg/mL, respectively. However, the VEGF level insignificantly increased before and after the procedure with values of 484.83+274.6 pg/mL and 498.79+257.7 pg/mL, respectively. Conclusion: There were no significant differences in prestin and VEGF levels before and after the IAHF procedure. However, there was a decrease in the prestin level and an increase in the VEGF level.

The Effect of the Intra-Arterial Heparin Flushing (IAHF) Procedure on Hearing Threshold in Sensorineural Hearing Loss Patients.

Sensorineural hearing loss (SNHL) is a frequent problem in Indonesia but its treatment is still limited. This type of hearing loss is related to oxidative stress and decreased vascularization, which can damage the hair cell. The intra-arterial heparin flushing (IAHF) is a procedure that can recover circulation and its agent, namely heparin, also has antioxidant activity. Therefore, the IAHF procedure has the potential to improve hearing function and can be considered an alternative therapy for SNHL. The study evaluates the effect of the IAHF on hearing improvement based on the difference in hearing threshold values before and after the procedure. This experimental study used a Pretest-Posttest One-Group Only design. A total of 17 patients with sensorineural hearing loss who met inclusion and exclusion criteria were subjected to pure tone audiometry tests before and 4 hours after the IAHF procedure. The mean difference in hearing threshold was analyzed using paired Students t-test for normally distributed data and Wilcoxon for non-normally distributed data. There was a decrease in the means of hearing threshold in the right and left ear 4 hours after the IAHF procedure. However, based on the paired Students t-test, there was not a significant difference in hearing threshold before and after the procedure (p-value > 0.05). There was hearing threshold improvement 4 hours after the IAHF procedure. This study showed that the IAHF procedure can have a therapeutic effect on sensorineural hearing loss patients.

Heparin-induced Thrombocytopenia after Open Heart Surgery Triggered by Heparin Flush Related to Central Venous Catheter Insertion: A Case Report

Heparin-induced Thrombocytopenia after Open Heart Surgery Triggered by Heparin Flush Related to Central Venous Catheter Insertion: A Case Report

Top tips regarding EUS-guided liver biopsy

Top tips regarding EUS-guided liver biopsy

A prospective, randomized study assessing different modalities for flushing totally implanted vascular access device in children with malignancy.

The totally implanted vascular access device (TIVAD) is commonly used in patients with malignant tumors requiring chemotherapy or long-term intravenous infusion and those with difficulty placing peripheral venous catheters. It could also be used to draw blood in pediatric patients. Thus, how to maintain the patency and longevity of TIVAD is always emphasized. In this prospective study, TIVAD was randomly infused in patients under 18 years with three different concentrations of heparinized solutions: 10 mL with 100 U/mL heparin, 20 mL with 10 U/mL heparin, and 30 mL with 10 U/mL heparin. A total of 81 patients (46 males and 35 females) were enrolled in this study from August 2, 2013 to February 1, 2017. The mean age of those who received TIVAD implantation was 7.2 ± 5.3 years, and the mean duration of using TIVAD was 1027.6 ± 369.1 days. Patients without catheter occlusion events experienced significantly shorter hospitalizations, fewer admissions, and fewer punctures than those with catheter occlusion events (p < 0.05). The administration and frequency of blood transfusions, history of bacteremia, and medication history did not increase the risk of catheter occlusion, but puncture frequency increased this risk. In patients with catheter occlusion events (38/81, 46.9%), catheter patency was restored after instillation of urokinase solution. In this study, the risk of TIVAD catheter occlusion was only related to puncture frequency regardless of the heparin flush composition or patient characteristics. A high puncture frequency of TIVAD during the 3.5-year study period significantly increased the risk of catheter occlusion. Besides, flushing and locking solutions for TIVAD using heparin at 10 U/mL was effective as using heparin at 100 U/mL regardless of the flushing volume of 10, 20, or 30 mL.

HEPARIN, TO CLOT OR NOT: IS IT NEEDED IN OOCYTE RETRIEVAL FLUSH MEDIA?

Heparin, a glycosaminoglycan, has historically been used in oocyte retrieval flush media for follicular aspirates to prevent the formation of clots that might hinder the identification and isolation of oocytes by embryologists.1 However, optimal follicle aspiration media has not been definitively established and there is no globally accepted formulation in regard to heparin.2-3 In 2018, a heparin shortage significantly reduced supply.4 Switching to a heparin-free flush media provided opportunity for fertility centers using heparin flush media to reduce costs and avoid unnecessary exposure of oocytes to a chemical, but how did it impact oocyte retrieval outcomes?

Effect of Heparinized Flush Concentration on Safety and Efficacy During Endovascular Thrombectomy for Acute Ischemic Stroke: Results from theMR CLEANRegistry.

Currently, there are no recommendations regarding the use of heparinized flush during endovascular thrombectomy (EVT) for acute ischemic stroke. Periprocedural heparin could, however, affect functional outcome and symptomatic intracranial hemorrhage (sICH). We surveyed protocols on heparin flush concentrations in DutchEVT centers and assessed its effect on safety and efficacy outcomes. Patients registered in theMR CLEAN Registry, from 2014 up to 2017 were included. We collected data on center protocols regarding heparin flush concentrations (IU/L) and grouped patients by their per protocol administered heparin flush concentration. We used a random effects model with random intercepts by EVT center and analyzed endpoints using regression models. Endpoints were sICH, mRS at 90days, mortality and reperfusion rates. A total of 3157 patients were included of which 45% (6 centers) received no heparin in the flush fluids, 1.8% (1 center) received flush fluids containing 2000IU/L heparin, 26% (4 centers) received 5000IU/L, 22% (4 centers) received 10.000IU/L and 5.6% (1 center) received 25.000IU/L. Higher heparin concentration was associated with increased sICH (aOR 1.15; 95% CI 1.02-1.29), but not with functional outcome, mortality or reperfusion rates. Effect of heparin in flush fluids should not be ignored by clinicians or researchers as higher concentrations may be associated with higher rates of ICH. The observed variation in protocols regarding heparin concentrations between EVT centers should encourage further studies, ideally in a controlled way, resulting in recommendations on heparin use in flush fluids in future guidelines.

The safety of modified digital subtraction angiography in RSPAD Gatot Soebroto: a comprehensive outlook

INTRODUCTION. There are no recent estimates of the complication rate associated with Intra Arterial Heparin Flushing (IAHF). The purpose of this study was to estimate the rate of complication occurring during and after Intra Arterial Heparin Flushing.METHOD. This report is a descriptive study based on analysis of interventional radiology database. The study involved patients who underwent IAHF procedure started from January 2018 until December 2018 in Rumah Sakit Pusat Angkatan Darat Gatot Soebroto (Indonesian Army Central Hospital). Subjects were assessed for their age, sex, medical history, diagnosis, intra-procedural complication, and post-procedural complication.RESULT. All IAHF procedures were performed via transfemoral catheterisation and using a vascular closure device to help achieve homeostasis. Our population included 1223 (70,57%) male and 510 (29,43%) Female, with age ranging from 21 to 80 years old. The majority of the subject was in 51-60 years old age group (35,31%). All IAHF were technically successful. No intraprocedural complication was noted, there was no occurrence of iatrogenic vessel injury (dissection) and no neurological deficit secondary to IAHF procedures. There was some local complication after IAHF procedure such as hematoma 44 persons (2,54%), oedema around the puncture site six patients (0,35%), and bleeding at the puncture site three patients (0,17%). Beside local complication, there were several systemic complications such as allergy in 10 persons (0,58%). No neurological complication was reported after IAHF.CONCLUSION. We concluded that IAHF has a relatively low rate of acute complication. Most complications were related to local hemostasis control, and no severe sequelae were found.

Heparin 'flush' induced thrombocytopenia triggered by total hip replacement: a case report.

BackgroundHeparin-induced thrombocytopenia (HIT) typically responds to heparin termination. Some types of HIT can persist after heparin discontinuation.Case summaryA 95-year-old woman was referred to the cardiology from orthopaedics because of acute limb ischaemia (ALI) 1 day after surgery of a femoral neck fracture. Despite thrombectomy, ALI relapsed the next day. She had been treated with intravenous antibiotics with a diagnosis of aspiration pneumonia for 1 week until 3 days before surgery, together with heparin flush twice a day. Of note, no intra-/post-operative heparin was administered, no cell salvage device, central venous, nor arterial catheters were used before development of ALI. The patient and her family refused reattempting invasive therapies; consequently, the patient continued to worsen and died on post-operative day 3. Diagnosis of autoimmune HIT, which was prompted by surgery without re-exposure to heparin, was confirmed posthumously.DiscussionThis case emphasizes the significance of suspecting autoimmune HIT in any patient presenting with thrombosis, even if the heparin exposure dates back more than a few days or even without heparin exposure.

Fluid Dynamic Analysis of IAHF (Intra Arterial Heparin Flushing) Stroke Therapy in Microfluidic Channel

Ischemic Stroke is a disease that inhibits blood supply to the brain. One method in handling ischemic stroke patient is Intra Arterial Heparin Flushing (IAHF) which has been claimed to be able to improve motoric function of a patient. However, in vitro clinical research to understand IAHF is scarce. One of in vitro methods can be applied is using microfluidic. This research aims to create a microfluidic system that can represents blood vessel system of a stroke patient and to quantify volumetric flow rate of 1,3-Propanediol (as a blood model) in microfluidic channels. Microfluidic which is made of acrylic with a square-wave design, is employed to represent a thrombotic ischemic stroke and embolic ischemic with the addition of wax to represent plaque in blood vessel. Various viscosity of 1,3-propanediol are applied (1.5 mPa. s; 4 mPa. s; 7.2 mPa. s) to represent the effects of heparin drug. The results indicate that fluid Reynold number in the microfluidic channel are 8.8023 x10−4 and 12.3230 x10−4 which is fall in the area of Reynold number laminar flow such as in blood vessels. Volumetric flow rate of 1,3-propanediol decreases when the viscosity increases and when wax is situated in the microfluidic channel. Diluted 1,3-propanediol (at a viscosity of 1.5 mpas) shows similar volumetric flow rate (when it passes through microfluidic channels with wax) with normal blood viscosity 4,0 mpas (when it passes microfluidic channels without wax). This similarity indicates an increase of blood flow when heparin is added in excess in IAHF method, which induces an improvement of organ motoric function.

The effect of intraarterial heparin flushing to autism symptoms when used to treat the concomitant cerebral venous thrombosis: a case series

Introduction. There are still no definite therapeutic strategies for Autism Spectrum Disorder (ASD) other than behavioural interventions and few FDA approved behaviour control drugs. In this study, we found a co-existence medical condition of ASD &amp; Cerebral Vein Thrombosis (CVT) in the paediatric population. Based on these findings, a new therapeutic approach, a catheter-directed anticoagulant therapy termed as IAHF (Intra Arterial Heparin Flushing) was performed on this population of patients.Methods. This paper aims to describe a series of 10 cases of IAHF procedure performed to treat CVT on children with ASD from 2018 through 2019 at Cerebrovascular Center RSPAD Gatot Soebroto Jakarta-Indonesia. The children diagnosed with ASD by the multidisciplinary team but also had CVT findings on their brain magnetic resonance imaging studies when performed as the series of comprehensive diagnostic examination. IAHF were conducted by delivering heparin through a modified DSA technique into the occluded vessels. Subject Autism status was assessed with the Childhood Autism Rating Scale (CARS) before and one month after IAHF procedures.Results. The measurement of CARS Score after IAHF shows a relatively positive result. Eight patients showed a decreased in total CARS Score after the procedure, while only two patients had no improvement. One subject shows a decrease of nine points, the most significant changes, and improved the status from moderate to mild autism.Conclusion. In children who have ASD and also accompanied by CVT findings in their imaging studies, IAHF treatment showed clinical improvement of the autism symptoms.Â

Short insight of pediatric cerebral venous thrombosis and the safety of intra-arterial heparin flushing as a new therapeutic method

Introduction. The incidence rate of Cerebral Venous Thrombosis (CVT) in children has been increased quite significantly due to the availability of advanced imaging technology and the trends of increasing awareness about health-related problem. Systemic anticoagulant was mainstay treatment for CVT. The author proposed a method of heparin deliveries through existing Digital Subtraction Angiography (DSA) procedure called Intra-arterial Heparin Flushing (IAHF). The safety of this procedure in children was still few known and reported. The purpose of this study is to provide insights on CVT and the potential complication of IAHF as the primary therapeutic modality.Methods. This was a descriptive longitudinal study involving all patients with age 0-18 years diagnosed with Cerebral Venous Thrombosis whom admitted in RSPAD Gatot Soebroto from 2016 to 2018 through MRI examination and will undergo IAHF Procedure as the primary treatment. All subject had signed informed consent regarding the nature of the study. The descriptive data were presented in tables and narratives.Results. The study found that the highest age group found in this study was between 6-12 years old (46,6%) with male-predominant (70,6%). The origins of the patients were mostly from Indonesia (88%) and several from Vietnam (12%). The most common symptoms of CVT in this study was the speech/communication problem (12%). The most common complication after IAHF procedure was wound swelling at the puncture site (2,6%).Conclusion. CVT predominantly affect male aged 6-12 years old with speech problem was the most common symptoms. IAHF procedure shown minimal side effects in pediatric with CVT.

Comparison of normal saline versus heparin flush solutions for maintaining patency of central venous catheter in cancer patients.

6501 Background: Published guidelines recommend normal saline (NS) flushes for maintaining patency of central venous catheters (CVCs) in cancer patients. The practice at a large oncology ambulatory facility was modified to use NS flushes instead of heparin for CVC maintenance (centrally inserted catheters and peripherally inserted central catheters, excluding implanted ports). The number of catheter occlusion events, pre- and post-implementation, was utilized to determine the effectiveness and safety of this practice change. Methods: Retrospective data of patients aged 18 years and older who presented to the ambulatory centers were collected from the electronic health record (EHR). The number of alteplase instillations was used as a surrogate measure for occlusion events. Ambulatory line-days, defined as patients arriving for an appointment and with either an active CVC or a CVC placement, was the denominator. The numerator was the number of ambulatory line-days with a catheter line and alteplase dose(s) given. The pre-intervention CVC maintenance period using heparin flushes was March 2016 - April 2017. The post-intervention CVC maintenance period using NS flushes was May 2017 - September 2018. Results: 95,089 line-days and 4,452 unique patients were analyzed pre-intervention and compared to 115,194 line-days and 5,575 unique patients post-intervention. The baseline incidence rate of occlusion was 0.91%, compared to the post-intervention incidence rate was 2.67% ( p &lt; 0.01). The increase started immediately within the first month of the practice change (2.26%) and continued throughout the post-implementation observation time. Conclusions: In an ambulatory oncology-practice setting with a high volume of CVC utilization, an increase in line occlusions rate was observed after implementing the practice change of flushing CVCs from heparin to NS. This raises concerns regarding safety and additional burdens to patients and caregivers, and additional analyses are ongoing to evaluate the further impact of this evaluation.

Heparin flush vs. normal saline flush to maintain the patency of central venous catheter among adult patients: A systematic review and meta-analysis.

Background:Around the globe, protocols for flushing the catheter to maintain the patency of central venous catheter (CVC) vary by institution to institution or by practitioner to practitioner. Therefore, this review was carried out with the aim of evaluating the efficacy of heparin flush vs. normal saline flush to maintain the patency of CVC among adult patients.Methods:We followed the guidelines of Cochrane handbook for interventions and searched in MEDLINE, Embase, Cochrane library, Clinical trials database, and reference list of related articles, which were published from Jan. 2012 to 31 Dec. 2018 in English language. We included only randomized controlled trials, and nine studies were included in this review. The pooled standard mean difference and relative risk were calculated by using Rev Man Review Manager 5.Results:We identified nine eligible studies with a total number of 3,113 participants. Consolidated results from eight studies conveyed little favorable effect to maintain patency of CVC with heparin when compared with normal saline as evident by risk ratio 0.83, 95% CI 0.50 – 1.40; P = 0.13. We also carried out analysis for secondary outcomes, and there was no evidence that heparin was better than normal saline in terms of safety except heparin-induced thrombocytopenia.Conclusions:Heparin has little favorable effects to maintain patency of catheter than normal saline but not in secondary outcomes. As the quality of evidence was very low, therefore, results should be comprehend with care.

A Prospective Study of Extending the Implanted Port Heparin Flushing Cycle in Outpatients with Solid Tumors

A Prospective Study of Extending the Implanted Port Heparin Flushing Cycle in Outpatients with Solid Tumors

Prevalence and Overtesting of True Heparin-Induced Thrombocytopenia in a 591-Bed Tertiary Care, Teaching Hospital.

Heparin-induced thrombocytopenia type II (HIT) is a rare but potentially fatal antibody-mediated reaction to all forms of heparin (unfractionated heparin, low-molecular weight heparin, heparin flushes, and heparin-coated catheters), which can lead to HIT with thrombosis. Two tests commonly used to screen for HIT include the enzyme-linked immunosorbent assay (ELISA) and serotonin release assay (SRA). This is a retrospective chart review study conducted from January 1, 2013, through December 31, 2014, to estimate the rate of true HIT in critical care patients at Winthrop-University Hospital, located in Mineola, New York. Patients are classified as positive for HIT if both ELISA and SRA immunoassays are positive. We reviewed 507 heparin immunoassays, excluding 64 who had an inappropriate ELISA test sent due to no administration of heparin, enoxaparin, or heparin lock flush at this or previous hospital stays at Winthrop. Of the 443 heparin immunoassays, ELISA results were positive for 66 patients (15.1%), and only 11 (2.5%) patients had true cases of HIT with a 95% confidence interval of 1.3% to 4.4%. The 4T score for those with true HIT (median: 5.0) was statistically higher compared to those without true HIT (median: 2.0; P < .001). Despite guidelines in place, overtesting for HIT is still a prevalent issue.

Progressive Pulmonary Hypertension and Lung Nodules Related to Intravenous Promethazine and Heparin Incompatibility.

SESSION TITLE: Miscellaneous SESSION TYPE: Global Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: This case describes a patient who had progressive embolic pulmonary hypertension and nodular lung disease related to intravenous heparin and promethazine drug incompatibility. CASE PRESENTATION: A 46-year-old woman with chronic relapsing pancreatitis under the supervision of a pain management specialist used self-administered promethazine injections through an implanted mediport at home. She presented to the hospital with abdominal pain, slowly progressive dyspnea on exertion, and a dry cough. Lab work demonstrated elevated liver function tests and CRP. Her chest x-ray showed borderline cardiomegaly and increased interstitial markings with reticular nodular opacities. CT angiography of the chest was negative for PE, but did confirm widespread poorly marginated small nodular densities as well as mild adenopathy. Bronchoscopy with BAL and wash was non-diagnostic. Her echo demonstrated an RVSP of 64 and a right heart catheter later confirmed moderate pulmonary HTN. Further lab workup for pulmonary HTN was negative. Pulmonary function testing showed restrictive disease with a reactive component. She required oxygen with exertion at discharge and was seen in close outpatient follow up for additional workup. Ten weeks later she was readmitted for symptom management of her severe abdominal pain. She denied any shortness of air or cough at that point in time. Repeat CT of the abdomen prompted chest imaging that demonstrated progressive widespread milliary nodular pattern of both lungs with progressive adenopathy. Echo demonstrated slight worsening of pulmonary hypertension. VATS was completed for surgical lung biopsy and pathology demonstrated an exuberant foreign body type reaction to polarizable amorphous foreign material associated with acute inflammation as well as focal microabscess formation. Cultures and stains for infectious organisms were negative. She denied illicit drug use and careful review of her outpatient medications revealed an in-line incompatibility of her IV heparin flushes and promethazine injections. MicroMedex IV compatibility listed the incompatibility as causing an increase in measured haze or turbidity, particulates and/or color change.1 Additional history was obtained and due to lack of readily available normal saline flushes, she had been using prefilled heparin syringes to flush her mediport after injecting promethazine. She was started on high dose prednisone that was slowly tapered over several months with normalization of her pulmonary hypertension on follow up echo. Follow up CT imaging demonstrated resolution of her adenopathy and improvement but incomplete resolution of her nodular airspace disease. DISCUSSION: The patient had been self-administering IV promethazine for nausea via an implanted port often several times per day. Her insurance company had only authorized a small allotment of prefilled saline syringes per month, but had provided a much larger allotment of prefilled heparin syringes for her to use for line maintenance. Due to this discrepancy, she would often use the more readily available heparin syringes as opposed to saline to flush her line after a promethazine dose. Incompatibility between IV promethazine and heparin led to precipitate formation that then embolized in the pulmonary circulation causing progressive pulmonary hypertension as well as diffuse micronodular airspace disease noted on CT. A progressive inflammatory reaction likely potentiated the progressive nodule growth. Treating the patient with steroids was successful in halting the inflammation and partial reversal of the disease process. Proper education about line maintenance and use of saline flushes prevented ongoing embolization. CONCLUSIONS: This case demonstrated the in-line incompatibility of IV promethazine and heparin had significant embolic effects on the pulmonary circulation. Obtaining a thorough history regarding utilization of home medications ultimately led to the diagnosis. Detailed attention as well as appropriate education and monitoring should be given to patients who self-administer IV medications via mediports. Reference #1: Truven Health Analytics MicroMedex IV compatability checker DISCLOSURE: The following authors have nothing to disclose: David Hasselbacher, Rebecca Parrish, Emma Coronel No Product/Research Disclosure Information

Review article: DOES INTRA-ARTERIAL HEPARIN FLUSHING (IAHF) CAN ACTUALLY INCREASE MANUAL MUSCLE TEST (MMT) SCORE IN CHRONIC ISCHEMIC STROKE PATIENTS?

Stroke is still a major health problem in the world. Ischemic stroke accounts for 87% of all acute stroke occurrences. In 2013, the American Heart Association (AHA)/American Stroke Association (ASA), published a Guideline for the Early Management of Patients with Acute Ischemic Stroke. The managements consist of the use of recombinant tissue plasminogen activator (rtPA), endovascular treatment, etc. Unlike acute ischemic stroke, until now, no guidelines have been provided about the management of chronic ischemic stroke that approved universally. The result of the study with the title of “Intra Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient” is very interesting, because it is a new attempt to treat patients with chronic ischemic stroke. The purpose of this article is to review the study mentioned above, in accordance with the applied scientific principles and is based on the standard literatures and guidelines. Our review is limited only to the discussion of the study results. From this discussion can be proved the existing references that support and/or refuse the study results. Based on the discussions and conclusions of this study, there were no references to support that IAHF can improve motor functions (muscles) in patients with chronic ischemic stroke.

Position Statement on Heparin Safety Concerns.

Position Statement on Heparin Safety Concerns.