PMID: 25765915Mar 15, 2015Paper

Heparin resistance and coagulation activation rebound effect after anticoagulant withdrawal: beneficiary effect of adjuvant antiplatelet therapy

International Angiology : a Journal of the International Union of Angiology
Michalis N GionisGrigoris T Gerotziafas

Abstract

Aim. The aim of this study was to investigate biological resistance to enoxaparin and rebound effect after prophylaxis withdrawal, using thrombin generation (TG) assay. Fifteen-patients undergoing femoro-popliteal bypass grafting (enoxaparin 4000 antiXaIU+75 mg clopidogrel), and 15-patients undergoing total-hip-replacement (THR) (enoxaparin alone). TG-assay parameters (lag-time, endogenous-thrombin-potential, peak-, time-to-peak, and Mean-Rate-Index) were assessed to investigate heparin resistance and rebound effect after prophylaxis interruption. Measurements were obtained preoperative, postoperative (before prophylaxis initiation), 8-days postoperative, and 48-hours after anticoagulant withdrawal (day 32). Surgery increased TG in vascular-patients despite intra-operative unfractioned heparin administration when compared to orthopedic patients (MRI:P=0.039, ETP:P=0.001, PGT:P=0.003), but this perioperative prothrombotic status was reversed by postoperative thromboprophylaxis. No thromboembolic events were observed. Similar TG parameter values between the 8th and 32nd postoperative day indicate that vascular patients were adequately protected after prophylaxis withdrawal, probably due to the synergic action of clopidogrel, whil...Continue Reading

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