Randomized trial of different regimens of heparins and in vivo thrombin generation in acute deep vein thrombosis.

Abstract

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 Blood samples withdrawn at the baseline and at weeks 1 and 3 were analyzed using markers of in vivo thrombin generation and other coagulation parameters.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.

• Authors: Vijay V Kakkar, Debra A Hoppenstead, Jawed Fareed, Zbigniew Kadziola, Mike Scully, Roumen Nakov, Hans K Breddin
• Journal: Blood (Blood) Vol. 99 Issue 6 Pg. 1965-70 (Mar 15 2002) ISSN: 0006-4971 [Print] United States
• PMID: 11877267 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Biomarkers
• Blood Coagulation Factors
• Heparin, Low-Molecular-Weight
• Vitamin K
• reviparin
• Heparin
• Thrombin

Topics

• Acute Disease
• Anticoagulants (administration & dosage, standards)
• Biomarkers (blood)
• Blood Coagulation Factors (drug effects, metabolism)
• Heparin (administration & dosage, standards)
• Heparin, Low-Molecular-Weight (administration & dosage, standards)
• Humans
• Partial Thromboplastin Time
• Prospective Studies
• Pulmonary Embolism (blood, drug therapy, pathology)
• Recurrence
• Thrombin (biosynthesis, drug effects)
• Venous Thrombosis (blood, drug therapy, pathology)
• Vitamin K (antagonists & inhibitors)