Document Detail

Hemostatic markers with bolus versus prolonged heparin after carotid artery stenting.
MedLine Citation:
PMID:  12679128     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The evolving technique of carotid stenting (CS) requires optimal antithrombotic strategies to reduce periinterventional thromboembolic risk. In animal models of balloon injury, tissue factor (TF) was shown to be the major procoagulant of the atherosclerotic plaque mediating prolonged procoagulant activity. METHODS: We analyzed TF and TF-dependent hemostatic markers before and 2, 6 and 24 h after CS with two antithrombotic drug regimens. Group A (n=20) received prolonged unfractionated heparin (UFH) for 18-20 h starting at intervention next to aspirin and thienopyridine. In group B (n=16), single bolus UFH was administered next to combined antiplatelet therapy. Natural anticoagulants were determined at baseline. RESULTS: Patients with symptomatic and asymptomatic cerebrovascular disease did not differ in plasma TF levels. Furthermore, no statistically significant difference for TF, TFPI/Xa-complex and prothrombin fragment F1.2 was observed between bolus and prolonged heparin treatment. No significant change was found in time course for these parameters. Two patients (5.5%; one in each treatment group) suffered periinterventional minor stroke associated with increased levels of F1.2 and TFPI/Xa-complex. Both were resistant to activated protein C (APC ratio<1.9) due to heterozygous factor V Leiden mutation. CONCLUSIONS: No significant activation of the TF pathway was seen with both antithrombotic regimens suggesting that single bolus UFH combined with antiplatelet therapy is generally sufficient to control TF-dependent procoagulant activity after CS. However, patients with resistance to activated protein C may be at increased periinterventional stroke risk.
Sabine Steiner; Ramazanali Ahmadi; Andrea Willfort; Wilfried Lang; Kurt Huber; Erich Minar; Christoph W Kopp
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Thrombosis research     Volume:  109     ISSN:  0049-3848     ISO Abbreviation:  Thromb. Res.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-04-07     Completed Date:  2004-01-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  23-9     Citation Subset:  IM    
Division of Angiology, 2nd Department of Internal Medicine, General Hospital, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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MeSH Terms
Anticoagulants / administration & dosage
Biological Markers / blood
Carotid Artery Diseases / blood,  therapy*
Drug Therapy, Combination
Hemostasis / drug effects*
Heparin / administration & dosage*
Lipoproteins / blood
Middle Aged
Peptide Fragments / blood
Platelet Aggregation Inhibitors / administration & dosage
Stents / adverse effects*
Thromboplastin / analysis*
Time Factors
Reg. No./Substance:
0/Anticoagulants; 0/Biological Markers; 0/Lipoproteins; 0/Peptide Fragments; 0/Platelet Aggregation Inhibitors; 0/lipoprotein-associated coagulation inhibitor; 0/prothrombin fragment 1.2; 9001-26-7/Prothrombin; 9005-49-6/Heparin; 9035-58-9/Thromboplastin

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