PMID- 10510988
OWN - NLM
STAT- MEDLINE
DCOM- 19991019
LR  - 20190812
IS  - 0003-9926 (Print)
IS  - 0003-9926 (Linking)
VI  - 159
IP  - 17
DP  - 1999 Sep 27
TI  - Recurrent venous thrombosis and heparin therapy: an evaluation of the importance 
      of early activated partial thromboplastin times.
PG  - 2029-32
AB  - BACKGROUND: The presence of an association between early subtherapeutic activated 
      partial thromboplastin times (aPTTs) and recurrent venous thromboembolism (VTE) 
      remains controversial. OBJECTIVE: To determine the relation between early 
      subtherapeutic aPTTs and recurrent VTE in patients who were treated with 
      intravenous (i.v.) unfractionated heparin (UFH). PATIENTS AND METHODS: We studied 
      961 patients with acute VTE who received i.v. UFH in 3 randomized trials that 
      compared the use of i.v. UFH (loading dose: 5000 U i.v.; initial infusion, 
      1250-1280 U/h) with that of subcutaneous low-molecular-weight heparin. According 
      to aPTT criteria, patients were classified as being in a subtherapeutic or a 
      therapeutic state during the first 24 and 48 hours of treatment. All episodes of 
      possible recurrent VTE were adjudicated by an independent committee that was 
      unaware of the aPTTs. RESULTS: At 24 hours, in 886 patients who were eligible for 
      the analysis, the rate of recurrent VTE in the subtherapeutic group was 6.7% 
      (11/163) compared with 5.3% (38/723) in the therapeutic group. The odds ratio for 
      recurrence in patients in the subtherapeutic vs the therapeutic group at 24 hours 
      was 1.30 (95% confidence interval: 0.64-2.63; P = .46). At 48 hours, in 917 
      patients who were eligible for the analysis, the rate of recurrent VTE in the 
      subtherapeutic group was 7.8% (5/64) compared with 5.7% (49/853) in the 
      therapeutic group. The odds ratio for recurrence in patients in the 
      subtherapeutic vs the therapeutic group at 48 hours was 1.32 (95% confidence 
      interval: 0.51-3.44; P = .56). CONCLUSION: In patients with acute VTE who receive 
      an i.v. bolus of 5000 U, followed by a starting dose of at least 1250 U/h of UFH, 
      a subtherapeutic aPTT response during the first 48 hours of treatment is not 
      associated with a large increase in the risk of recurrent VTE.
FAU - Anand, S S
AU  - Anand SS
AD  - Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 
      anands@fhs.mcmaster.ca
FAU - Bates, S
AU  - Bates S
FAU - Ginsberg, J S
AU  - Ginsberg JS
FAU - Levine, M
AU  - Levine M
FAU - Buller, H
AU  - Buller H
FAU - Prins, M
AU  - Prins M
FAU - Haley, S
AU  - Haley S
FAU - Kearon, C
AU  - Kearon C
FAU - Hirsh, J
AU  - Hirsh J
FAU - Gent, M
AU  - Gent M
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Arch Intern Med
JT  - Archives of internal medicine
JID - 0372440
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/administration & dosage/*therapeutic use
MH  - Drug Administration Schedule
MH  - Female
MH  - Heparin/administration & dosage/*therapeutic use
MH  - Humans
MH  - Infusions, Intravenous
MH  - Injections, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - *Partial Thromboplastin Time
MH  - Randomized Controlled Trials as Topic
MH  - Recurrence
MH  - Time Factors
MH  - Treatment Outcome
MH  - Venous Thrombosis/blood/*drug therapy/*prevention & control
EDAT- 1999/10/08 00:00
MHDA- 1999/10/08 00:01
CRDT- 1999/10/08 00:00
PHST- 1999/10/08 00:00 [pubmed]
PHST- 1999/10/08 00:01 [medline]
PHST- 1999/10/08 00:00 [entrez]
AID - 10.1001/archinte.159.17.2029 [doi]
PST - ppublish
SO  - Arch Intern Med. 1999 Sep 27;159(17):2029-32. doi: 10.1001/archinte.159.17.2029.