title: Coagulation parameters in patients with cirrhosis and portal vein thrombosis treated sequentially with low molecular weight heparin and vitamin K antagonists.
abstract: OBJECTIVE
  Information on coagulation for cirrhotics on anticoagulants is scanty. We investigated plasma from 23 cirrhotics treated with low-molecular-weight-heparin (LMWH) followed by vitamin K antagonists (VKA).
  
  
  METHODS
  On days 1-4 patients received full-dose LMWH. On day-5 VKA was started and LMWH was terminated when INR therapeutic-interval was reached. Blood was collected at peak and trough during LMWH, LMWH+VKA and VKA. Non-cirrhotics on VKA were included as controls.
  
  
  RESULTS
  Anti-factor Xa increased from baseline-to-peak during LMWH. During LMWH+VKA was high and reverted to zero during VKA. INR was slightly high at baseline, trough or peak during LMWH and increased to 2.2 during LMWH+VKA or VKA. Mean VKA weekly-doses for cirrhotics and controls were 28.5mg and 28.6mg. Protein C decreased upon VKA, but not to the expected extent. Endogenous-thrombin-potential (ETP) decreased from baseline (1436nMmin) to trough (1258nMmin) and peak (700nMmin) during LMWH and was further reduced during LMWH+VKA (395nMmin).
  
  
  CONCLUSIONS
  Target-INR for cirrhotics can be reached by VKA dosages similar to those for non-cirrhotics. ETP reduction parallels the effect of LMWH and/or VKA. Whether these parameters represent the antithrombotic action elicited by these drugs remains to be determined by clinical-trials and laboratory-measurements. ETP, being a global-test reflecting both pro- and anti-coagulants targeted by antithrombotic drugs, seems the candidate for these trials.
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy. Electronic address: armando.tripodi@unimi.it.
authors.forename: Armando
authors.initials: A
authors.lastname: Tripodi
authors.affiliation: First Division of Gastroenterology, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Primignani
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy.
authors.forename: Simon
authors.initials: S
authors.lastname: Braham
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy.
authors.forename: Veena
authors.initials: V
authors.lastname: Chantarangkul
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy.
authors.forename: Marigrazia
authors.initials: M
authors.lastname: Clerici
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moia
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy.
authors.forename: Flora
authors.initials: F
authors.lastname: Peyvandi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001779:Blood Coagulation Factors / Q000032:analysis*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007558:Italy; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K
keywords: Anti-FXa activity; Anticoagulation; Antithrombin; Factor II; Factor VIII; INR; Protein C; Thrombin generation