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Titolo:
Oral anticoagulation thresholds
Autore:
Brummel, KE; Paradis, SG; Branda, RF; Mann, KG;
Indirizzi:
Univ Vermont, Coll Med, Dept Biochem, Burlington, VT 05405 USA Univ Vermont Burlington VT USA 05405 pt Biochem, Burlington, VT 05405 USA Univ Vermont, Coll Med, Dept Med, Burlington, VT 05405 USA Univ Vermont Burlington VT USA 05405 , Dept Med, Burlington, VT 05405 USA
Titolo Testata:
CIRCULATION
fascicolo: 19, volume: 104, anno: 2001,
pagine: 2311 - 2317
SICI:
0009-7322(20011106)104:19<2311:OAT>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
VITAMIN-K; VENOUS THROMBOEMBOLISM; BLOOD-COAGULATION; THERAPY; PROTHROMBIN; HEMOSTASIS; WARFARIN;
Keywords:
anticoagulants; hemorrhage; coagulation; thrombosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
28
Recensione:
Indirizzi per estratti:
Indirizzo: Mann, KG Univ Vermont, Coll Med, Dept Biochem, Given Bldg,Rm C401,Hlth SciComplex,Burlington, VT 05405 USA Univ Vermont Given Bldg,Rm C401,Hlth Sci Complex Burlington VT USA 05405
Citazione:
K.E. Brummel et al., "Oral anticoagulation thresholds", CIRCULATION, 104(19), 2001, pp. 2311-2317

Abstract

Background-Monitoring patients on oral anticoagulation is essential to prevent hemorrhage and recurrent thrombosis. We studied tissue factor-induced whole-blood coagulation in patients, on warfarin therapy with similar international normalized ratios (INRs). Methods and Results-Contact pathway-suppressed whole-blood coagulation initiated with tissue factor was studied in 8 male subjects (group W) and in Iindividual multiple times (subject A). Coagulation profiles for group W showed that subjects with similar INRs had widely varying clot times (6.2 to 23 minutes) and thrombin-antithrombin III (TAT) profiles with rates of 25 to 40 nmol . L-(1) . min(-1) and maximum levels varying from 192 to 349 nmol/L. The normal control group exhibited clot times of 5.7 +/-0.3 minutes andTAT rates of 57 +/- 13 nmol . L-1 . min(-1), reaching maximum levels of 742 +/- 91 nmol/L. Subject A, who was stably anticoagulated at an INR of 2.1 /-0.4 for 6 months, had widely ranging profiles with clot times of 9.0 to 22.7 minutes, TAT maximums varying from 141 to 345 nmol/L, and TAT formation rates of 10 to 57 nmol . L-1 . min(-1). INR did not correlate with TAT formation. Platelet activation was decreased by anticoagulants but also displayed variability. Fibrinopeptide A generation showed threshold variability independent of the INR. Factor VIII levels were increased (P=0.03) in groupW (204 +/- 34.4%) compared with normal control subjects (149.4 +/- 37.4%). A significant correlation was identified between increasing factor VIII levels and years on warfarin therapy (r=0.78, P=0.01), suggesting a possible factor VIII compensatory mechanism. Conclusions-These results suggest that control of anticoagulation in patients to a set INR therapeutic range may be less secure than anticipated. Patients with similar INRs show significant individual variability in their tissue factor coagulation response, suggesting different risks to anticoagulation when confronted with underlying vascular anomalies.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 14/07/20 alle ore 06:01:08