Document Detail


Long term administration of LMWH - pharmacodynamic parameters under therapeutic or prophylactic regimen of enoxaparin or tinzaparin in neurological rehabilitation patients.
MedLine Citation:
PMID:  19625075     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We investigated anti-FXa- and anti-FIIa-activity, thrombin generation (ETP), tissue factor pathway inhibitor (TFPI) - and D-dimer in patients exhibiting high bleeding risk in early neurological rehabilitation over 2 months in an observational study. Blood of 64 patients under LMWH administration due to therapeutic (cohort 1 [tinzaparin 90 IE/kg BID, N = 18] and 2 [enoxaparin 100 IE/kg BID; N = 15]) or prophylactic (cohort 3 [tinzaparin 4500 IE; N = 16] and 4 [enoxaparin 4000 IE; N = 15]) indication was drawn before and 4h after injection on day 7 (V1) and 2 months (follow up [V2]). Although the dose in cohort 1 and 2 was similar (median 7000 IE BID), a-FXa-activity was significantly larger under enoxaparin than under tinzaparin (e.g. median at V2: 0.70 IU/ml vs. 0.33 IU/ml). Also, prophylactic enoxaparin exhibited larger a-FXa-activity than tinzaparin (e.g. median at V2: 0.37 IU/ml vs. 0.22 IU/ml). The a-FXa/a-FIIa-ratio in plasma samples at 4h p.a. was about 4 (tinzaparin) and 8 (enoxaparin), respectively. No differences were seen for TFPI and ETP between cohort 1 and 2 or between cohort 3 and 4. D-dimer levels decreased significantly between V1 (e.g. cohort 4 median 1940 ng/ml) and V2 (median 652 ng/ml). Minimal bleeding events occurred in 6 patients (2 under tinzaparin, 4 under enoxaparin) and were associated with significantly higher anti-FXa-activity. In conclusion, although marked differences between tinzaparin and enoxaparin based on anti-FXa-activity were seen, markers of in vivo biological activity such as TFPI and D-dimer were not different. Furthermore, BID tinzaparin is a feasible option for therapeutic anticoagulation in patients with high bleeding risk.
Authors:
K Kuczka; K Baum; B Picard-Willems; S Harder
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-07-21
Journal Detail:
Title:  Thrombosis research     Volume:  124     ISSN:  1879-2472     ISO Abbreviation:  Thromb. Res.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-19     Completed Date:  2010-02-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  625-30     Citation Subset:  IM    
Affiliation:
Pharmazentrum frankfurt/ZAFES, Institute of Clinical Pharmacology at the Johann Wolfgang Goethe University Frankfurt, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anticoagulants / administration & dosage*
Drug Administration Schedule
Enoxaparin / administration & dosage*
Female
Fibrin Fibrinogen Degradation Products / metabolism
Fibrinolytic Agents / administration & dosage*
Hemorrhage / chemically induced,  drug therapy,  prevention & control*
Heparin, Low-Molecular-Weight / administration & dosage*
Humans
Lipoproteins / metabolism
Male
Middle Aged
Nervous System Diseases / blood*,  rehabilitation*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Enoxaparin; 0/Fibrin Fibrinogen Degradation Products; 0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight; 0/Lipoproteins; 0/fibrin fragment D; 0/lipoprotein-associated coagulation inhibitor; 0/tinzaparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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