Objectives: This study compared rebound coagulation in patients with acute coronary syndrome patients after discontinuation of unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH).
Background: Up to a quarter of patients hospitalized for unstable angina experience recurrent ischemia after discontinuation of UFH or LMWH therapy, which may be the result of rebound coagulation activation and subsequent thrombosis. It is unknown whether UFH and LMWH differ in this respect.
Methods: We randomized 71 patients admitted with unstable angina to intravenous UFH or subcutaneous LMWH (dalteparin) and measured plasma markers of coagulation before, during, and after treatment.
Results: A complete series of measurements was obtained in 59 patients. Plasma prothrombin fragment 1+2 (F(1+2)) levels decreased in both groups during treatment. After loss of therapeutic plasma drug levels, F(1+2) increased (within 3 h) to a maximum level at 12 to 24 h that was higher than before or during treatment in both groups (p < 0.0001). In both groups, F(1+2) levels remained higher than pretreatment up to 24 h after discontinuation. Similarly, thrombin-antithrombin (TAT) levels exceeded treatment and pretreatment levels, at a slower rate after dalteparin than after UFH. However, after dalteparin a higher peak value of TAT was observed.
Conclusions: Rebound coagulation activation occurs within hours after discontinuation of both UFH and dalteparin. With both drugs, thrombin generation is significantly greater after treatment than before or during treatment. A longer duration or weaning of treatment, or continuation with another anticoagulant treatment, may reduce rebound coagulation activation and ischemic events.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/s0735-1097(01)01825-3 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Thromboelastography may assess the effect of anticoagulation reversal in intracranial hemorrhage.
J Stroke Cerebrovasc Dis
January 2025
Department of Neurology, University of Iowa College of Medicine, United States; Department of Epidemiology, University of Iowa College of Public Health, United States; Department of Neurosurgery, University of Iowa College of Medicine, United States.
Article Synopsis
- Intracranial hemorrhage (ICH) is a serious risk for patients on oral anticoagulants, and there's a need for biomarkers to evaluate the effectiveness of reversal agents like activated prothrombin complex concentrate (aPCC).
- A study was conducted in an emergency department with adult patients experiencing factor Xa inhibitor-related ICH to assess changes in thromboelastography (TEG) following aPCC reversal.
- Results showed a significant decrease in TEG R-time shortly after aPCC administration, but it returned to baseline levels by 12 and 24 hours, suggesting TEG R-time could be a valuable biomarker to monitor anticoagulation effects in these patients.
Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study.
J Cardiothorac Surg
January 2025
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, China.
Background: Heparin, an anticoagulant used in cardiac surgery, can result in heparin rebound (HR), where it returns postoperatively despite being neutralized with protamine. This study was designed to investigate the prevalence of HR in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and evaluate the impact of HR on their short-term outcomes.
Methods: HR was defined by a 10% increase in activated coagulation time (ACT) following two hours of heparin neutralization with protamine, bleeding over 200 mL/h, and abnormal laboratory coagulation examination results.
Comparison of the pharmacokinetics and pharmacodynamics of apixaban and rivaroxaban in dogs.
J Vet Intern Med
November 2024
Comparative Coagulation Laboratory, Department of Population Medicine and Diagnostic Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA.
Background: Comparative pharmacokinetics and pharmacodynamics (PK/PD) of apixaban and rivaroxaban have not been studied in dogs and the propensity of these drugs to cause hypercoagulability after discontinuation is unknown.
Hypothesis: Compare the PK/PD of clinical dosing regimens of PO apixaban and rivaroxaban administered repeatedly to healthy dogs and assess the effect of abrupt drug discontinuation on coagulation.
Animals: Six University-owned, purpose-bred, middle-aged, mixed-breed dogs (4 male, 2 female).
Gastric perforation and generalized peritonitis due to heterotopic pancreas, an unusual case report.
Int J Surg Case Rep
November 2024
Department of Surgery, Medical South, Private, Mexico City, Mexico.
Introduction: Heterotopic pancreas is the presence of normal pancreatic tissue that is in an anatomical site different from the pancreas.
Case Report: Adolescent who was admitted to the emergency room due to intense, generalized abdominal pain, which did not go away with anything, was exacerbated with movements, 24 h later vomiting that occurred as soon as he ate food was added, and severe and progressive abdominal distention, reason for admission to the service of emergencies. He had no significant family or personal medical history.
Eosinophilic gastroenteritis-induced intestinal obstruction.
Rev Esp Enferm Dig
September 2024
Gastroenterology , First Affiliated Hospital. China Medical University.
A 53-year-old man presented with abdominal pain and distension, accompanied with vomiting, and weight loss. Then he was treated with gastrointestinal decompression and enema, but the symptom of abdominal pain and distension continued with no relief. He had no drug or food allergies.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!