| Antithrombin III supplementation for patients undergoing PTCA for unstable angina pectoris. A controlled randomized double-blind pilot study. | |
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MedLine Citation:
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PMID: 9076381 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Thrombin activation may be a higher risk for complications and restenosis after percutaneous transluminal coronary angioplasty in unstable patients than in patients with stable angina pectoris. The effects of heparin may be partly counteracted by a decrease in antithrombin (III). The primary objectives of this study were to evaluate whether a subnormal antithrombin level was associated with a hypercoagulable state and to evaluate the effects of antithrombin supplementation, before and after percutaneous transluminal coronary angioplasty, on biochemical signs of coagulation activation. Secondary objectives were to evaluate acute complications and restenosis rate at 3 months. METHODS: In a double-blind pilot study, 50 patients with unstable angina, with ongoing heparin infusion and with subnormal antithrombin levels (< 85%) were randomized to receive antithrombin supplementation or placebo. Treatment targeted to an antithrombin level of 120% was started with a 2h intravenous infusion before the percutaneous transluminal coronary angioplasty and was repeated, if there were further subnormal values, every 12th hour for 48 h. RESULTS: Angiographic success was 20/25 in the antithrombin group and 21/25 in the placebo group (ns). Abrupt closure occurred in two and one patients in the two groups, respectively. Activation of coagulation measured as elevations of prothrombin fragment 1+2, thrombin-antithrombin complexes and fibrin D-dimer was seen 2 days after the procedure. Baseline levels of fibrin D-dimer were 68 +/- 69 micrograms.l-1 in the antithrombin group vs 71 +/- 46 micrograms.l-1 in the placebo group (ns). Two days after percutaneous transluminal coronary angioplasty the levels increased to 135 +/- 103 vs 242 +/- 150 micrograms.l-1, respectively (P < 0.05 between the groups). Restenosis at 3 months occurred in 4/20 antithrombin patients and in 8/21 placebo patients (ns). CONCLUSIONS: In unstable angina patients with heparin treatment and subnormal antithrombin levels, anti-thrombin supplementation resulted in less activation of coagulation and a tendency towards less restenosis. |
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Authors:
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L Grip; M Blombäck; N Egberg; A Olsson; B Svane; M Velander |
Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: European heart journal Volume: 18 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 1997 Mar |
Date Detail:
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Created Date: 1997-05-23 Completed Date: 1997-05-23 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 443-9 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Karolinska Hospital, Stockholm, Sweden. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angina, Unstable
/
blood,
radiography,
therapy* Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects Anticoagulants / administration & dosage, therapeutic use Antithrombin III / administration & dosage, therapeutic use* Blood Coagulation / drug effects Blood Coagulation Factors / analysis Combined Modality Therapy Coronary Angiography Coronary Disease / blood, radiography, therapy Double-Blind Method Female Heparin / administration & dosage, therapeutic use Humans Infusions, Intravenous Male Middle Aged Pilot Projects Recurrence |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Blood Coagulation Factors; 9000-94-6/Antithrombin III; 9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
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Eur Heart J. 1997 Mar;18(3):362-3
[PMID:
9076371
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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