PMID- 11869846
OWN - NLM
STAT- MEDLINE
DCOM- 20020320
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 39
IP  - 5
DP  - 2002 Mar 6
TI  - Rebound thrombin generation after heparin therapy in unstable angina. A 
      randomized comparison between unfractionated and low-molecular-weight heparin.
PG  - 811-7
AB  - 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.
FAU - Bijsterveld, Nick R
AU  - Bijsterveld NR
AD  - Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands.
FAU - Moons, Arno H
AU  - Moons AH
FAU - Meijers, Joost C M
AU  - Meijers JC
FAU - Tijssen, Jan G P
AU  - Tijssen JG
FAU - Buller, Harry R
AU  - Buller HR
FAU - Levi, Marcel
AU  - Levi M
FAU - Peters, Ron J G
AU  - Peters RJ
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.5 (Thrombin)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Angina, Unstable/blood/*drug therapy/physiopathology
MH  - Anticoagulants/blood/*therapeutic use
MH  - Coronary Thrombosis/blood/physiopathology/*prevention & control
MH  - Dalteparin/blood/*therapeutic use
MH  - Female
MH  - Fibrinolysis/drug effects/physiology
MH  - Heparin/blood/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/blood/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Recurrence
MH  - Thrombin/drug effects/physiology
MH  - Time Factors
MH  - *Withholding Treatment
EDAT- 2002/03/01 10:00
MHDA- 2002/03/21 10:01
CRDT- 2002/03/01 10:00
PHST- 2002/03/01 10:00 [pubmed]
PHST- 2002/03/21 10:01 [medline]
PHST- 2002/03/01 10:00 [entrez]
AID - S0735109701018253 [pii]
AID - 10.1016/s0735-1097(01)01825-3 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2002 Mar 6;39(5):811-7. doi: 10.1016/s0735-1097(01)01825-3.