PMID- 31803745
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2296-858X (Print)
IS  - 2296-858X (Electronic)
IS  - 2296-858X (Linking)
VI  - 6
DP  - 2019
TI  - Heparins: A Shift of Paradigm.
PG  - 254
LID - 10.3389/fmed.2019.00254 [doi]
LID - 254
AB  - Heparins inhibit the thrombin forming capacity of plasma, i. e., the endogenous 
      thrombin potential (ETP), by their anti-thrombin (aIIa) activity, the anti-factor 
      Xa (aXa) activity is of minimal importance. This holds for both unfractionated 
      heparin (UFH) and low molecular weight heparin (LMWH) at aXa/aIIa ratios < 25. 
      Clinical experience and epidemiological evidence show a direct relationship 
      between the ETP and the risk of thrombosis and bleeding. Consequently, the 
      therapeutic potency of a heparin is determined by its aIIa activity, i.e., the 
      concentration of a domain in which 12 sugar flank the high affinity 
      antithrombin-binding pentasaccharide (HA5) at one side. The response of 
      individual plasmas to a fixed dose of any heparin is highly variable. This 
      suggests that individualization of heparin dosage, on basis of the ETP, might 
      reduce bleeding or re-thrombosis. There exist simple laboratory methods for both 
      the ETP and the concentration of the active domain. These methods can be used 
      both for unequivocally characterization of a heparin preparation and for 
      controlling heparin therapy and allow arbitrary units relative to a standard to 
      be abandoned. These tests are as robust as any hematological routine test but not 
      yet routinely available, which severely encumbers progress in the field.
CI  - Copyright (c) 2019 Hemker, Al Dieri and Beguin.
FAU - Hemker, H Coenraad
AU  - Hemker HC
AD  - Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), 
      Maastricht University, Maastricht, Netherlands.
FAU - Al Dieri, Raed
AU  - Al Dieri R
AD  - Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), 
      Maastricht University, Maastricht, Netherlands.
FAU - Beguin, Suzette
AU  - Beguin S
AD  - Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), 
      Maastricht University, Maastricht, Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20191115
PL  - Switzerland
TA  - Front Med (Lausanne)
JT  - Frontiers in medicine
JID - 101648047
PMC - PMC6872674
OTO - NOTNLM
OT  - activated partial thromboplastin time (aPTT)
OT  - anti-factor Xa activity
OT  - anti-thrombin activity
OT  - endogenous thrombin potential (ETP)
OT  - heparin
OT  - low molecular weight heparin (LMWH)
OT  - personalized medicine
OT  - thrombin generation
EDAT- 2019/12/06 06:00
MHDA- 2019/12/06 06:01
PMCR- 2019/11/15
CRDT- 2019/12/06 06:00
PHST- 2018/10/31 00:00 [received]
PHST- 2019/10/22 00:00 [accepted]
PHST- 2019/12/06 06:00 [entrez]
PHST- 2019/12/06 06:00 [pubmed]
PHST- 2019/12/06 06:01 [medline]
PHST- 2019/11/15 00:00 [pmc-release]
AID - 10.3389/fmed.2019.00254 [doi]
PST - epublish
SO  - Front Med (Lausanne). 2019 Nov 15;6:254. doi: 10.3389/fmed.2019.00254. 
      eCollection 2019.