Recurrent venous thrombosis and heparin therapy -: An evaluation of the importance of early activated partial thromboplastin times

被引:67
作者
Anand, SS
Bates, S
Ginsberg, JS
Levine, M
Buller, H
Prins, M
Haley, S
Kearon, C
Hirsh, J
GEnt, M
机构
[1] McMaster Univ, Dept Med, Hamilton, ON L8L 2X2, Canada
[2] Univ Amsterdam, Acad Med Ctr, Ctr Hemostasis Thrombosis Atherosclerosis & I, NL-1105 AZ Amsterdam, Netherlands
关键词
D O I
10.1001/archinte.159.17.2029
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The presence of an association between early subtherapeutic activated partial thromboplastin times (aPTTs) and recurrent venous thromboembolism (VTE) remains controversial. Objective: To determine the relation between early subtherapeutic aPTTs and recurrent VTE in patients who were treated with intravenous (IV) unfractionated heparin (UFH). Patients and Methods: We studied 961 patients with acute VTE who received IV UFH in 3 randomized trials that compared the use of IV UFH (loading dose: 5000 U IV; initial infusion, 1250-1280 U/h) with that of subcutaneous low-molecular-weight heparin. According to aPTT criteria, patients were classified as being in a subtherapeutic or a therapeutic state during the first 24 and 48 hours of treatment. All episodes of possible recurrent VTE were adjudicated by an independent committee that was unaware of the aPTTs. Results: At 24 hours, in 886 patients who were eligible for the analysis, the rate of recurrent VTE in the subtherapeutic group was 6.7% (11/163) compared with 5.3% (38/723) in the therapeutic group. The odds ratio for recurrence in patients in the subtherapeutic vs the therapeutic group at 24 hours was 1.30 (95% confidence interval: 0.64-2.63; P = .46). At 48 hours, in 917 patients who were eligible for the analysis, the rate of recurrent VTE in the subtherapeutic group was 7.8% (5/64) compared with 5.7% (49/853) in the therapeutic group. The odds ratio for recurrence in patients in the subtherapeutic vs the therapeutic group at 48 hours was 1.32 (95% confidence interval: 0.51-3.44; P = .56). Conclusion: In patients with acute VTE who receive an IV bolus of 5000 U, followed by a starting dose of at least 1250 U/h of UFH, a subtherapeutic aPTT response during the first 48 hours of treatment is not associated with a large increase in the risk of recurrent VTE.
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页码:2029 / 2032
页数:4
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