The effect of operation and subcutaneous heparin on plasma levels of antithrombin-iii

Harbourne, T.; Nicolaides, Andrew

doi:10.1016/0049-3848(86)90102-7

Thrombosis Research

1986

DOI: 10.1016/0049-3848(86)90102-7

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The effect of operation and subcutaneous heparin on plasma levels of antithrombin-iii

T. Harbourne

Andrew Nicolaides

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Cited by 7 publications

(1 citation statement)

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“…However, there is an alternative explanation. Recent findings [17][18][19][20][21][22][23][24][25][26][27] of reduced antithrombin I11 levels in patients on intravenous heparin point to a probable hypercoagulable state. We propose that simultaneous ad-ministration of warfarin with heparin initiation may provide more time to increase or maintain plasma antithrombin I11 levels, and prevent rethrombosis upon heparin discontinuance.…”

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confidence: 99%

Hypothesis: Warfarin administered simultaneously with heparin infusion will prevent heparin‐discontinuance associated coronary Thrombosis

Craddock

Miller

Krumbach

et al. 1990

Cathet. Cardiovasc. Diagn.

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Recent studies have evidenced an association between the time of heparin discontinuance and coronary artery reocclusion. Some investigators have concluded that inadequate heparinization was responsible, and further heparin infusion or an increase in dose would have been indicated. However, several investigators (Rao: Thrombosis Research 24:181-186, 1981; Marciniak and Gockerman: Lancet September 17:581-584, 1977; Fisken et al.: Lancet December 10: 1231, 1977; Conard et al.: Thrombosis Research 22:507-511, 1981; Kakkar et al.: Lancet January 12:103-104; Green: Lancet February 16:374, 375; Harborne and Nicolaides: Thrombosis Research 43:657-662, 1986; Bonen et al.: Thrombosis Research 27:123-124, 1982; Blomback et al.: Acta Physiologica Scandinavica 58:306-318, 1963; Holm et al.: Scandinavian Journal of Haematology 35:564-569, 1985; Andersson et al.: Thrombosis Research 34:333-340, 1984) have demonstrated that antithrombin III levels are reduced in patients on intravenous heparin. Both reduced antithrombin III levels and reduced rate of antithrombin inhibition of thrombin at the time of heparin discontinuance may increase the risk of coronary rethrombosis. If this theory is correct, increasing heparin infusion may exacerbate this risk. We propose an investigation that will provide evidence for or against the decreased antithrombin III theory, and in doing so, test an experimental therapy designed to prevent coronary reocclusion upon heparin discontinuance. In a randomized, placebo-controlled double-blinded study, we will determine whether simultaneous administration of warfarin with heparin initiation provides more time to increase antithrombin III levels and prevent coronary reocclusion upon heparin discontinuance, compared to heparin without warfarin therapy.

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mentioning

confidence: 99%

Hypothesis: Warfarin administered simultaneously with heparin infusion will prevent heparin‐discontinuance associated coronary Thrombosis

Craddock

Miller

Krumbach

et al. 1990

Cathet. Cardiovasc. Diagn.

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Hemostasis in liver transplantation

Porte¹,

Knot²,

Bontempo³

1989

Gastroenterology

112

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Research Initiatives in Vascular Surgery*

1990

Journal of Vascular Surgery

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Special communication 195ably similar to that of streptokinase, and has the advantage ,that it can be administered by bolus injection. Singlechain urokinase-type plasminogen activator is more fbrinspecific than urokinase. Comparative data on the efficacy and safety of this agent are limited as it is in the early stage of clinical investigation.Reduction of infarction size, preservation ofventricular function, and/or reduction in mortality have been observed with streptokinase, rt-PA, and APSAC. Therefore thromboiytic therapy will probably become routine therapy for early acute myocardial infarction.All available thrombolytic agents still suffer significant shortcomings, including the need for large doses to be therapeutically efficient, a limited fibrin-specificity, and re-~sidual toxicity in terms of bleeding complications. New developments toward further improved efficacy and fibrinspecificity of thrombolytic therapy include the use of combinations of synergistic thrornbolytic agents, mutants ,~: t-PA and scu-PA, chimeric t-PA/scu-PA molecules, antibody-targeted thrombolytic agents, and/or combinations of fibrin-dissolving agents with antiplatelet strategies.

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The effect of operation and subcutaneous heparin on plasma levels of antithrombin-iii

Cited by 7 publications

References 20 publications

Hypothesis: Warfarin administered simultaneously with heparin infusion will prevent heparin‐discontinuance associated coronary Thrombosis

Hypothesis: Warfarin administered simultaneously with heparin infusion will prevent heparin‐discontinuance associated coronary Thrombosis

Hemostasis in liver transplantation

Research Initiatives in Vascular Surgery*

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