Comparison of Markers of Coagulation Activation in Patients Under Oral Anticoagulation at Different Levels

Wersch, J. W. J. Van; Mourik-Alderliesten, C. H. van; Coremans, A.

doi:10.1515/cclm.1992.30.8.461

Cited by 10 publications

(7 citation statements)

References 25 publications

(17 reference statements)

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“…• TAT is a useful tool for the diagnosis of hypercoagulable states and for monitoring therapy in DIC, tumors, and high risk pregnancy 17,32 • TAT is a marker of still-present thrombin generation after thrombolysis in AMI [33][34][35] and a prognostic marker for reocclusion 36 • Fl + 2 is useful for diagnosis not only of hypercoagulable but also of hypocoagulable states 4,15 It can be used for monitoring of thrombin activity dur ing anticoagulant therapy with coumarins and hep arins [37][38][39] • Fl + 2 is, like TAT, a good parameter for monitoring therapy of DIC. 40…”

Section: Tat and F1 + 2 Are Markers Of Activation Of Coagulationmentioning

confidence: 99%

Relevance of Markers of Hemostasis Activation in Obstetrics/Gynecology and Pediatrics

Dati

Pelzer²,

Wagner³

1998

Semin Thromb Hemost

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Pregnancy and puerperium are considered to be hypercoagulable states with increased incidence of thromboembolic events. During normal pregnancy, changes in the hemostatic mechanism involve increased stasis and increased coagulation factors and/or decreased levels of anticoagulant proteins such as protein C and protein S as well as enhanced thrombin generation and decreased fibrinolytic activity. The physiological or pathophysiological activation of hemostasis during pregnancy results in the generation of the so-called activation markers which increase, reflecting hypercoagulability and therefore representing an imbalance in the hemostatic system. The most interesting markers of hemostasis activation and, thus, of thrombin generation are: thrombin-antithrombin III complex (TAT), antithrombin III itself, prothrombin fragment 1+2 (F 1+2), fibrin monomer (soluble fibrin) and D-Dimer (which indicates also an increased fibrinolytic activity). Together with fibrinogen levels and platelet counts, the activation markers are useful tools in different pathological situations in pregnancy to predict and monitor the severity of the condition. Recently, a higher incidence of factor V Leiden mutation has been demonstrated in selected populations in whom thrombotic events developed during pregnancy and puerperium. Therefore, the combination of APC resistance/FV Leiden mutation and pregnancy may predict a high risk for thromboembolic phenomena. In newborns, the activation markers are elevated immediately after birth and decline to near adult levels during the first 24 h of life. During infections the activation markers are increased showing the same behavior as in the mature adult system. In neonates and children, the same etiologies can be responsible for acquired and inherited pathological hypercoagulable states as in the adult.

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Section: Tat and F1 + 2 Are Markers Of Activation Of Coagulationmentioning

confidence: 99%

Relevance of Markers of Hemostasis Activation in Obstetrics/Gynecology and Pediatrics

Dati

Pelzer²,

Wagner³

1998

Semin Thromb Hemost

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“…21 Van Wersch and colleagues have found a decrease in TAT with increasing INRs only in patients with mechanical heart valves, but did not find the same in patients anticoagulated for other indications at similar INRs. 22 The data presented demonstrate a reduction of antithrombin-enzyme complex levels of patients on oral anticoagulants, without a trend that is evident with degree of anticoagulation. Despite a lack of correlation with INR, ATM measures did correlate significantly with FPA in the INR >3.0 group.…”

Section: Discussionmentioning

confidence: 72%

Markers ofIn VivoActivation of Coagulation:Interrelationships Change With Intensity of Oral Anticoagulation

Solymoss¹,

Bovill²

1996

Am J Clin Pathol

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“…Firstly, full-dose warfarin was used up to the day prior to valvuloplasty in 10 out of 12 patients, resulting in a mean INR of 2.1 immediately before the valvuloplasty procedure. Given that this degree of INR prolongation is known to markedly suppress F1j2 levels [9,[16][17][18][19][20][21] and our previous report that even minor prolongation of the INR is associated with both lower venous and left atrial F1j2 levels and an attenuated leftatrial-venous F1j2 difference [5], it is surprising that Yamamoto et al [7] found not only peripheral venous levels of F1j2 in the range found in patients with a normal INR [4,16], but also a more than 2-fold difference between left atrial and peripheral venous F1j2 levels. Secondly, a comparison of femoral venous (0.85 nmol\l) and femoral artery (2.09 nmol\l) F1j2 levels in the study of Yamamoto et al [7] indicates that 50 % clearance of this coagulation marker occurred within its first passage across the lower limb.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence that arterial F1j2 levels may be elevated in mitral stenosis has been presented as part of a brief report by Yamamoto et al [7], but the significance of this observation was limited by two factors. First, most patients were anticoagulated with warfarin, a drug which decreases coagulation activity [8,9], and it is thus unclear to what extent arterial F1j2 levels are altered in the presence of normal clotting times. Secondly, the presence of only 12 patients in the study group precluded comparison of arterial and venous F1j2 levels in the presence and absence of increased left atrial thrombin generation.…”

Section: Introductionmentioning

confidence: 99%

Increased left atrial thrombin generation in mitral stenosis is not reflected in arterial prothrombin fragment 1+2 levels

Peverill¹,

HARPER²,

GAN³

et al. 2000

Clinical Science

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A proportion of patients with mitral stenosis have increased left atrial thrombin generation, with elevated left atrial but normal peripheral venous levels of prothrombin fragment 1+2 (F1+2). Whether this pattern of left atrial and venous F1+2 levels is related to limited spillover of F1+2 from the left atrium into the systemic circulation, or to washout of increased left atrial F1+2 production into the arterial circulation with subsequent systemic clearance, is unclear. We examined the relationship between arterial and venous F1+2 levels in mitral stenosis patients without left atrial thrombus. The study group comprised 36 patients with either a normal (n=29) or prolonged (n=7) international normalized ratio (INR; a measure of clotting time) who were undergoing percutaneous balloon mitral valvuloplasty. Baseline arterial and venous blood samples were collected at the beginning of the valvuloplasty procedure, and left atrial and venous samples were collected after trans-septal puncture. The left atrial F1+2 level exceeded the corresponding venous level in patients with a normal INR (P<0.03); however, baseline arterial and venous F1+2 levels were similar. Arterial and venous F1+2 levels were also similar in the subgroup of patients with evidence of a regional increase in left atrial thrombin generation, and were not different from arterial and venous F1+2 levels in patients without such an increase. Baseline arterial and venous F1+2 levels were both lower in the presence of a prolonged INR. Thus the pattern of increased left atrial but normal venous F1+2 levels in mitral stenosis is due to limited spillover from the left atrium into the systemic circulation.

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Comparison of Markers of Coagulation Activation in Patients Under Oral Anticoagulation at Different Levels

Cited by 10 publications

References 25 publications

Relevance of Markers of Hemostasis Activation in Obstetrics/Gynecology and Pediatrics

Relevance of Markers of Hemostasis Activation in Obstetrics/Gynecology and Pediatrics

Markers ofIn VivoActivation of Coagulation:Interrelationships Change With Intensity of Oral Anticoagulation

Increased left atrial thrombin generation in mitral stenosis is not reflected in arterial prothrombin fragment 1+2 levels

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