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This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kakkar, V. V. Articles by Breddin, H. K. Search for Related Content PubMed PubMed Citation Articles by Kakkar, V. V. Articles by Breddin, H. K. Related Collections Hemostasis, Thrombosis, and Vascular Biology Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 March 2002, Vol. 99, No. 6, pp. 1965-1970 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Randomized trial of different regimens of heparins and in vivo thrombin generation in acute deep vein thrombosis Vijay V. Kakkar, Debra A. Hoppenstead, Jawed Fareed, Zbigniew Kadziola, Mike Scully, Roumen Nakov, and Hans K. Breddin From the Thrombosis Research Institute, Chelsea, London, United Kingdom; Haemostasis and Thrombosis Research Laboratories, Loyola University Medical Center, Maywood, Illinois; Knoll AG, Ludwigshafen, Germany; and International Institute of Thrombosis and Vascular Diseases, Frankfurt, Germany. Low-molecular-weight and unfractionated heparins are frequently used to treat venous thromboembolism, but it is not known whether they are equally effective in inhibiting in vivo generation of thrombin. In this multicenter trial, 1048 patients were randomized to intravenous unfractionated heparin (group A), twice daily low-molecular-weight heparin (reviparin) for 1 week (group B), or once daily reviparin for 4 weeks (group C). All patients received vitamin K antagonists. Blood samples withdrawn at the baseline and at weeks 1 and 3 were analyzed using markers of in vivo thrombin generation and other coagulation parameters. During the first 3 weeks symptomatic recurrent deep vein thrombosis-pulmonary embolism (DVT/PE) occurred in 17 (4.5%) of 375 patients in group A compared with 4 (1.0%) of 388 patients in group B, and 9 (2.4%) of 374 patients in group C. Forty percent of patients in group A, 53.4% in group B, and 53.5% in group C showed 30% or greater reduction in thrombus size assessed by venography. Patients in group B had significantly greater reduction in D-dimer, prothrombin fragments 1 and 2 (F1 + 2), endogenous thrombin potential (ETP), and thrombin-antithrombin (TAT) complexes compared to groups A and C. Greater release of tissue factor pathway inhibitor (TFPI) and reduction in levels of thrombin activatable fibrinolysis inhibitor (TAFI) and fibrinogen were significantly more pronounced in group C patients. Reviparin administered twice daily plus vitamin K antagonist is more effective in inhibiting in vivo thrombin generation compared to intravenous unfractionated heparin plus vitamin K antagonist, and reviparin once daily produced significantly higher TFPI release and greater reduction in TAFI and fibrinogen levels. © 2002 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: J. A. Sjoland, R. Smith Pedersen, J. Jespersen, and J. Gram Intraperitoneal heparin reduces peritoneal permeability and increases ultrafiltration in peritoneal dialysis patients Nephrol. Dial. Transplant., May 1, 2004; 19(5): 1264 - 1268. [Abstract] [Full Text] [PDF]

	Copyright © 2002 by American Society of Hematology         Online ISSN: 1528-0020