PMID- 12575965
OWN - NLM
STAT- MEDLINE
DCOM- 20030225
LR  - 20191210
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 41
IP  - 3
DP  - 2003 Feb 5
TI  - The activated clotting time can be used to monitor the low molecular weight 
      heparin dalteparin after intravenous administration.
PG  - 394-402
AB  - OBJECTIVES: This study was designed to compare the dose response of dalteparin 
      versus unfractionated heparin (UFH) on the activated clotting time (ACT), and to 
      determine whether the ACT can be used to monitor intravenous (IV) dalteparin 
      during percutaneous coronary intervention (PCI). BACKGROUND: The use of low 
      molecular weight heparin (LMWH) during PCI has been limited by the presumed 
      inability to monitor its anticoagulant effect using bedside assays. METHODS: This 
      study was performed in three phases. In vitro, ACTs were measured on volunteer (n 
      = 10) blood samples spiked with increasing concentrations of dalteparin or UFH. 
      To extend these observations in vivo, ACTs were then measured in patients (n = 
      15) who were sequentially treated with IV dalteparin and then UFH. Finally, a 
      larger monitoring study was undertaken involving patients (n = 110) who received 
      dalteparin 60 or 80 international U (IU)/kg alone or followed by abciximab. We 
      measured ACT (Hemochron), activated partial thromboplastin time (aPTT), plasma 
      anti-Xa and anti-IIa levels, tissue factor pathway inhibitor (TFPI) 
      concentration, and plasma dalteparin concentration. RESULTS: Dalteparin induced a 
      significant rise in the ACT with a smaller degree of variance as compared to UFH. 
      Five min after administration of IV dalteparin 80 IU/kg the ACT increased from 
      125 s (122 s, 129 s) to 184 s (176 s, 191 s) (p < 0.001). The aPTT, anti-Xa and 
      anti-IIa activities, and TFPI concentration also demonstrated significant 
      increases following IV dalteparin. CONCLUSIONS: The ACT and aPTT are sensitive to 
      IV dalteparin at clinically relevant doses. These data suggest that the ACT may 
      be useful in monitoring the anticoagulant effect of intravenously administered 
      dalteparin during PCI.
FAU - Marmur, Jonathan D
AU  - Marmur JD
AD  - Department of Medicine, Division of Cardiology, SUNY Health Science Center at 
      Brooklyn, 450 Clarkson Avenue, Box 1257, Brooklyn, NY 11203, USA. 
      jonathan@marmur.com
FAU - Anand, Sunil X
AU  - Anand SX
FAU - Bagga, Ramanjit S
AU  - Bagga RS
FAU - Fareed, Jawed
AU  - Fareed J
FAU - Pan, Chi-Miau
AU  - Pan CM
FAU - Sharma, Samin K
AU  - Sharma SK
FAU - Richard, Merwin F
AU  - Richard MF
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
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  - 9005-49-6 (Heparin)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Anticoagulants/*administration & dosage/*therapeutic use
MH  - Coronary Disease/*therapy
MH  - Dalteparin/*administration & dosage/*therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Heparin/*administration & dosage/*therapeutic use
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Intraoperative/*methods
MH  - Partial Thromboplastin Time
MH  - *Whole Blood Coagulation Time
EDAT- 2003/02/11 04:00
MHDA- 2003/02/26 04:00
CRDT- 2003/02/11 04:00
PHST- 2003/02/11 04:00 [pubmed]
PHST- 2003/02/26 04:00 [medline]
PHST- 2003/02/11 04:00 [entrez]
AID - S0735109702027626 [pii]
AID - 10.1016/s0735-1097(02)02762-6 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2003 Feb 5;41(3):394-402. doi: 10.1016/s0735-1097(02)02762-6.