PMID- 33725411
OWN - NLM
STAT- MEDLINE
DCOM- 20210708
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7933 (Print)
IS  - 1538-7836 (Linking)
VI  - 19
IP  - 6
DP  - 2021 Jun
TI  - Heparins have adequate ex vivo anticoagulant effects in hospitalized patients 
      with cirrhosis.
PG  - 1472-1482
LID - 10.1111/jth.15296 [doi]
AB  - BACKGROUND: Patients with cirrhosis are at risk of venous thromboembolism (VTE), 
      but strategies for thromboprophylaxis have not been defined. Previous in vitro 
      studies suggest an altered anticoagulant effect of heparins in patients with 
      cirrhosis. OBJECTIVES: To assess the anticoagulant effects of prophylactic 
      low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) doses in 
      patients with cirrhosis in a real-life clinical setting. METHODS: We studied 
      patients with cirrhosis (n = 16) and acute-on-chronic liver failure (ACLF) 
      (n = 14), and compared these with patients without underlying liver disease 
      admitted to non-liver general medical wards (n = 18) and non-liver intensive care 
      units (n = 14), respectively. Blood samples were taken before and 4 h after 
      administration of the first dose of LMWH or UFH. We assessed hemostatic status 
      using thrombin generation assays, thrombin-antithrombin complexes (TAT), and 
      conventional coagulation assays, and included healthy controls (n = 20) to 
      establish reference values. Anti-Xa activity was determined to estimate peak 
      heparin levels. RESULTS: Baseline thrombin generation was similar among all 
      cohorts and healthy controls despite alterations in conventional coagulation 
      assays. On heparin, both absolute and proportional changes of thrombin generation 
      were comparable between all four cohorts (-62% to -85%). TAT levels decreased in 
      all cohorts apart from the ACLF cohort, but did not correlate with the 
      proportional change in thrombin generation. Anti-Xa activity correlated with the 
      proportional change in thrombin generation in patients receiving LMWH, but not in 
      patients receiving UFH. CONCLUSIONS: These data suggest that current prophylactic 
      heparin doses have comparable anticoagulant effects in patients with cirrhosis 
      compared with patients without underlying liver disease.
CI  - (c) 2021 The Authors. Journal of Thrombosis and Haemostasis published by Wiley 
      Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.
FAU - van den Boom, Bente P
AU  - van den Boom BP
AUID- ORCID: 0000-0003-3793-4176
AD  - Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver 
      Transplantation, Department of Surgery, University of Groningen, University 
      Medical Center Groningen, Groningen, The Netherlands.
FAU - von Meijenfeldt, Fien A
AU  - von Meijenfeldt FA
AUID- ORCID: 0000-0003-0274-2414
AD  - Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver 
      Transplantation, Department of Surgery, University of Groningen, University 
      Medical Center Groningen, Groningen, The Netherlands.
FAU - Adelmeijer, Jelle
AU  - Adelmeijer J
AD  - Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver 
      Transplantation, Department of Surgery, University of Groningen, University 
      Medical Center Groningen, Groningen, The Netherlands.
FAU - Roberts, Lara N
AU  - Roberts LN
AUID- ORCID: 0000-0003-3871-8491
AD  - King's Thrombosis Centre, Department of Haematological Medicine, King's College 
      Hospital NHS Foundation Trust, London, UK.
FAU - Bernal, William
AU  - Bernal W
AD  - Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, 
      UK.
FAU - Lisman, Ton
AU  - Lisman T
AUID- ORCID: 0000-0002-3503-7140
AD  - Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, 
      UK.
LA  - eng
PT  - Journal Article
DEP - 20210409
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - *Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Liver Cirrhosis/complications/diagnosis/drug therapy
MH  - *Venous Thromboembolism/diagnosis/drug therapy
PMC - PMC8252552
OTO - NOTNLM
OT  - acute-on-chronic liver failure
OT  - heparin
OT  - liver cirrhosis
OT  - low-molecular-weight heparin
OT  - venous thromboembolism
COIS- The authors declare no competing interests.
EDAT- 2021/03/17 06:00
MHDA- 2021/07/09 06:00
PMCR- 2021/07/02
CRDT- 2021/03/16 17:46
PHST- 2021/03/02 00:00 [revised]
PHST- 2021/02/08 00:00 [received]
PHST- 2021/03/08 00:00 [accepted]
PHST- 2021/03/17 06:00 [pubmed]
PHST- 2021/07/09 06:00 [medline]
PHST- 2021/03/16 17:46 [entrez]
PHST- 2021/07/02 00:00 [pmc-release]
AID - S1538-7836(22)00782-6 [pii]
AID - JTH15296 [pii]
AID - 10.1111/jth.15296 [doi]
PST - ppublish
SO  - J Thromb Haemost. 2021 Jun;19(6):1472-1482. doi: 10.1111/jth.15296. Epub 2021 Apr 
      9.