title: Recombinant human factor VIIa and a factor VIIa-analogue reduces heparin and low molecular weight heparin (LMWH)-induced bleeding in rats.
abstract: BACKGROUND
  Heparin and low molecular weight heparin (LMWH) are widely used for prevention and treatment of thromboemobolic events, but may occasionally cause uncontrollable bleeding. Heparin can readily be antagonized with protamine, but this is less effective against LMWH.
  
  
  OBJECTIVE
  To test the effects of rFVIIa or an analogue of rFVIIa, NN1731, on heparin- and LMWH-induced bleeding in rats.
  
  
  METHODS
  Initially the doses of heparin and tinzaparin (a LMWH) were determined by dose-titration. Following pretreatment with heparin or tinzaparin in rats, tail-transection was performed, and the effect of rFVIIa and NN1731 on the bleeding was observed.
  
  
  RESULTS
  rFVIIa (5, 10 and 20 mg kg(-1)) reduced bleeding time and blood loss caused by heparin- and tinzaparin-induced bleeding, using doses of 200 IU kg(-1) (n = 8) and 500 IU kg(-1) (n = 9), respectively. Similarly, 10 mg kg(-1) NN1731 significantly reduced both heparin- and tinzaparin-induced bleeding to the normal level. Following severe anticoagulation with 1800 IU kg(-1) tinzaparin, 10 mg kg(-1) NN1731 reduced and normalized the bleeding, while the effect of 20 mg kg(-1) rFVIIa failed to reach statistical significance. These data are consistent with the hypothesis that rFVIIa/NN1731 are capable of generating sufficient thrombin locally on the surface of activated platelets to induce hemostasis in the presence of heparin/LMWH.
  
  
  CONCLUSIONS
  This study suggests that rFVIIa and NN1731 may have the potential to control bleedings caused by heparin or LMWH.
authors.affiliation: Research and Development, Novo Nordisk A/S, Måløv, Denmark. blz@novonordisk.com
authors.forename: B
authors.initials: B
authors.lastname: Lauritzen
authors.forename: U
authors.initials: U
authors.lastname: Hedner
authors.forename: P B
authors.initials: PB
authors.lastname: Johansen
authors.forename: M
authors.initials: M
authors.lastname: Tranholm
authors.forename: M
authors.initials: M
authors.lastname: Ezban
mesh_terms: D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects; D004347:Drug Interactions; D005167:Factor VII / Q000008:administration & dosage / Q000494:pharmacology; D015942:Factor VIIa / Q000008:administration & dosage / Q000494:pharmacology*; D006470:Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D051381:Rats; D011994:Recombinant Proteins; D000078222:Tinzaparin; D017186:Titrimetry
chemical_list: D006495:Heparin, Low-Molecular-Weight; C519901:NN1731; D011994:Recombinant Proteins; D000078222:Tinzaparin; D005167:Factor VII; D006493:Heparin; C103587:recombinant FVIIa; D015942:Factor VIIa