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Rebound thrombin generation after heparin therapy in unstable angina

A randomized comparison between unfractionated and low-molecular-weight heparin

Nick R. Bijsterveld, MD^*, Arno H. Moons, MD^*, Joost C. M. Meijers, PhD, Jan G. P. Tijssen, PhD^*, Harry R. Büller, MD, PhD, Marcel Levi, MD, PhD and Ron J. G. Peters, MD, PhD^*,*

^* Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands
Department of Vascular Medicine, Academic Medical Center, Amsterdam, Netherlands

View larger version (11K): [in a new window]   Figure 1 Schematic anticoagulation levels of unfractionated heparin (UFH) and low-molecular-weight heparin and definition of discontinuation time point for UFH and dalteparin. (a) last dose of dalteparin; (b) cessation of UFH, discontinuation time point; (c) discontinuation time point for dalteparin.

View larger version (12K): [in a new window]   Figure 2 Median plasma levels of prothrombin fragment 1+2 (F1+2) before, during, and after unfractionated heparin (UFH) and dalteparin treatment. Black diamond = UFH; white square = dalteparin. Samples were obtained before treatment start (pre), 24 h after start (on), at discontinuation of UFH or dalteparin treatment (stop) and at 3, 6, 12, 24 and 48 h after discontinuation of treatment (3, 6, 12, 24, 48, respectively). Interquartile range of the values at the various time points was 0.75 for UFH and 0.56 for dalteparin.

View larger version (12K): [in a new window]   Figure 3 Median plasma levels of thrombin-antithrombin complexes (TAT) before, during, and after unfractionated heparin (UFH) and dalteparin treatment. Black diamond = UFH; white square = dalteparin. Samples were obtained before treatment start (pre), 24 h after start (on), at discontinuation of UFH or dalteparin treatment (stop) and at 3, 6, 12, 24 and 48 h after discontinuation of treatment (3, 6, 12, 24, 48, respectively). Interquartile range of the values at the various time points was 15.6 for UFH and 11.9 for dalteparin.

View larger version (11K): [in a new window]   Figure 4 Median plasma levels of plasmin-antiplasmin (PAP) before, during, and after unfractionated heparin (UFH) and dalteparin treatment. Black diamond = UFH; white square = dalteparin. Samples were obtained before treatment start (pre), 24 h after start (on), at discontinuation of UFH or dalteparin treatment (stop) and at 3, 6, 12, 24 and 48 h after discontinuation of treatment (3, 6, 12, 24, 48, respectively). Interquartile range of the values at the various time points was 269.2 for UFH and 292.0 for dalteparin.

View larger version (12K): [in a new window]   Figure 5 Median plasma levels of anti-factor Xa (anti-Xa) before, during, and after unfractionated heparin (UFH) and dalteparin treatment. Black diamond = UFH; white square = dalteparin. Samples were obtained before treatment start (pre), 24 h after start (on), at discontinuation of UFH or dalteparin treatment (stop) and at 3, 6, 12, 24 and 48 h after discontinuation of treatment (3, 6, 12, 24, 48, respectively).