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.
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Letrozole has been used for ovarian stimulation by fertility doctors since 2001 because it has fewer side-effects than clomiphene ( Clomid ) and less chance of multiple gestation. A study of 150 babies following treatment with letrozole or letrozole and gonadotropins presented at the American Society of Reproductive Medicine 2005 Conference found no difference in overall abnormalities but did find a significantly higher rate of locomotor and cardiac abnormalities among the group having taken letrozole compared to natural conception.  A larger, follow-up study with 911 babies compared those born following treatment with letrozole to those born following treatment with clomiphene.  That study also found no significant difference in the rate of overall abnormalities, but found that congenital cardiac anomalies was significantly higher in the clomiphene group compared to the letrozole group. Despite this, India banned the usage of letrozole in 2011, citing potential risks to infants.  In 2012, an Indian parliamentary committee said that the drug controller office colluded with letrozole's makers to approve the drug for infertility in India and also stated that letrozole's use for infertility was illegal worldwide;  however, such off-label uses are legal in many countries such as the US and UK.