Heparin Assays and Bleeding Complications in Treatment of Deep Venous Thrombosis with Particular Reference to Retroperitoneal Bleeding

Abstract

SummaryBleeding complications occurred in 30 (11%) out of 280 patients who received continuous heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients (3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified plasma [CaTT]). The differences in median heparin activity between patients with minor bleeding and patients with no bleeding did not reach significance for any of the tests. In patients with major bleeding, the differences were significant with the CS (p = .011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003), APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days of heparin treatment, but there was a considerable overlap with patients without bleeding.

Subcutaneous Heparin Treatment of Deep Venous Thrombosis: A Comparison of Unfractionated and Low Molecular Weight Heparin

“…We have previously shown that clinical and phlé bographie results of heparin treatment are related to plasma anti-Xa activity using a CS assay [1,2]. Dose adjustment to obtain com parable anti-Xa activities, reflecting antico agulant effect, was therefore an important part of the study design.…”

“…Monitoring, especially using chromogenic substrate (CS) assays, may increase the efficacy and safety of heparin treatment [1,2]. Continuous intrave nous infusion is preferred by most clinicians, but subcutaneous administration of heparin has also been shown to be useful in the treat ment of DVT and is comparable to intrave nous infusions [3][4][5] in efficacy.…”

Heparin Treatment in 52 Patients with Progressive Ischemic Stroke

“…Labo ratory m onitoring failed to show excessive anticoagula tion in those who bled [5,8]. It is well known that bleeding during heparin therapy depends largely on individual fac tors [22] and it may be that our material comprised fewer patients with predisposition to bleeding.…”

Heparin inhibition of von Willebrand factor-dependent platelet function in vitro and in vivo.

“…Hemorrhagic complications of heparin anticoagulant therapy remain a significant clinical problem (1)(2)(3). Although some studies suggest that bleeding complications may be more common when the anticoagulant effects ofheparin are excessive (as judged by coagulation assays), serious bleeding may occur in spite of satisfactory monitoring and control (2).…”