کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5655912 | 1407331 | 2016 | 6 صفحه PDF | دانلود رایگان |
Background/aimsInformation on coagulation for cirrhotics on anticoagulants is scanty. We investigated plasma from 23 cirrhotics treated with low-molecular-weight-heparin (LMWH) followed by vitamin K antagonists (VKA).MethodsOn days 1-4 patients received full-dose LMWH. On day-5 VKA was started and LMWH was terminated when INR therapeutic-interval was reached. Blood was collected at peak and trough during LMWH, LMWHÂ +Â VKA and VKA. Non-cirrhotics on VKA were included as controls.ResultsAnti-factor Xa increased from baseline-to-peak during LMWH. During LMWHÂ +Â VKA was high and reverted to zero during VKA. INR was slightly high at baseline, trough or peak during LMWH and increased to 2.2 during LMWHÂ +Â VKA or VKA. Mean VKA weekly-doses for cirrhotics and controls were 28.5Â mg and 28.6Â mg. Protein C decreased upon VKA, but not to the expected extent. Endogenous-thrombin-potential (ETP) decreased from baseline (1436Â nMÂ min) to trough (1258Â nMÂ min) and peak (700Â nMÂ min) during LMWH and was further reduced during LMWHÂ +Â VKA (395Â nMÂ min).ConclusionsTarget-INR for cirrhotics can be reached by VKA dosages similar to those for non-cirrhotics. ETP reduction parallels the effect of LMWH and/or VKA. Whether these parameters represent the antithrombotic action elicited by these drugs remains to be determined by clinical-trials and laboratory-measurements. ETP, being a global-test reflecting both pro- and anti-coagulants targeted by antithrombotic drugs, seems the candidate for these trials.
Journal: Digestive and Liver Disease - Volume 48, Issue 10, October 2016, Pages 1208-1213