PMID- 12479885
OWN - NLM
STAT- MEDLINE
DCOM- 20031112
LR  - 20190727
IS  - 0049-3848 (Print)
IS  - 0049-3848 (Linking)
VI  - 107
IP  - 5
DP  - 2002 Sep 1
TI  - In vitro comparison of the effect of heparin, enoxaparin and fondaparinux on 
      tests of coagulation.
PG  - 241-4
AB  - Low-molecular weight heparin (LMWH) is increasingly used in place of 
      unfractionated heparin (UFH) in patients with unstable angina, and phase II 
      clinical trials using fondaparinux for this indication are underway. Because 
      unstable angina patients often require urgent percutaneous coronary interventions 
      (PCI) or aortocoronary bypass surgery, a point-of-care test is needed to monitor 
      the anticoagulant effect of these agents. The activated clotting time (ACT) and 
      activated partial thromboplastin time (aPTT) are the tests most often used to 
      monitor heparin. The purpose of this in vitro study was to determine whether the 
      ACT or the aPTT can be used to monitor the anticoagulant effect of low-molecular 
      weight heparin and fondaparinux. The ACT and aPTT were measured after heparin, 
      enoxaparin or fondaparinux was added to the blood of healthy volunteers, in doses 
      with equivalent inhibitory activity against activated factor X (factor Xa). To 
      mimic the clinical scenario where an unstable angina patient, who has already 
      received enoxaparin, is urgently taken for PCI or bypass surgery, the ACT was 
      determined after heparin was added to blood containing clinically relevant doses 
      of enoxaparin. We determined that enoxaparin produced significantly less 
      prolongation of both the ACT and the aPTT than heparin, whereas fondaparinux had 
      no effect on either of these tests. Addition of enoxaparin to heparin-containing 
      plasma did not prolong the ACT beyond that produced by heparin alone. The ACT and 
      aPTT therefore cannot be used to monitor low-molecular weight heparin or 
      fondaparinux, highlighting the need for a point-of-care anti-factor Xa assay.
FAU - Linkins, Lori Ann
AU  - Linkins LA
AD  - Henderson Research Centre and McMaster University, 711 Concession Street, 
      Hamilton, Ontario, Canada L8V 1C3.
FAU - Julian, Jim A
AU  - Julian JA
FAU - Rischke, Janice
AU  - Rischke J
FAU - Hirsh, Jack
AU  - Hirsh J
FAU - Weitz, Jeffrey I
AU  - Weitz JI
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Polysaccharides)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Anticoagulants/*pharmacology
MH  - Blood Coagulation/*drug effects
MH  - Dose-Response Relationship, Drug
MH  - Drug Evaluation
MH  - Enoxaparin/*pharmacology
MH  - Fondaparinux
MH  - Heparin/*pharmacology
MH  - Humans
MH  - Partial Thromboplastin Time
MH  - Polysaccharides/*pharmacology
MH  - Whole Blood Coagulation Time
EDAT- 2002/12/14 04:00
MHDA- 2003/11/13 05:00
CRDT- 2002/12/14 04:00
PHST- 2002/12/14 04:00 [pubmed]
PHST- 2003/11/13 05:00 [medline]
PHST- 2002/12/14 04:00 [entrez]
AID - S0049384802003407 [pii]
AID - 10.1016/s0049-3848(02)00340-7 [doi]
PST - ppublish
SO  - Thromb Res. 2002 Sep 1;107(5):241-4. doi: 10.1016/s0049-3848(02)00340-7.