Abstract
Intravenous heparin after thrombolytic therapy for acute myocardial infarction is an effective, widely used treatment. Six cases of acute myocardial infarction are reported with early disease reactivation following the abrupt discontinuation of heparin infusion three days after alteplase thrombolysis and concomitant aspirin therapy. Immediate reinfusion of heparin resulted in regression of symptomatic ischaemia in all six patients. The activated partial thromboplastin time values, determined four hours before the discontinuation of heparin therapy, were within the therapeutic range in five of the six patients, and no difference was found in the values obtained one hour after the reinfusion of heparin (P = 0.065).
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arnout J., Simoons M., de Bono D., Rapold H. J., Collen D., Verstraete M. Correlation between level of heparinization and patency of the infarct-related coronary artery after treatment of acute myocardial infarction with alteplase (rt-PA). J Am Coll Cardiol. 1992 Sep;20(3):513–519. doi: 10.1016/0735-1097(92)90001-4. [DOI] [PubMed] [Google Scholar]
- Becker R. C., Corrao J. M., Ball S. P., Gore J. M. A comparison of heparin strategies after thrombolytic therapy. Am Heart J. 1993 Sep;126(3 Pt 1):750–752. doi: 10.1016/0002-8703(93)90442-c. [DOI] [PubMed] [Google Scholar]
- Cruickshank M. K., Levine M. N., Hirsh J., Roberts R., Siguenza M. A standard heparin nomogram for the management of heparin therapy. Arch Intern Med. 1991 Feb;151(2):333–337. [PubMed] [Google Scholar]
- Gold H. K., Torres F. W., Garabedian H. D., Werner W., Jang I. K., Khan A., Hagstrom J. N., Yasuda T., Leinbach R. C., Newell J. B. Evidence for a rebound coagulation phenomenon after cessation of a 4-hour infusion of a specific thrombin inhibitor in patients with unstable angina pectoris. J Am Coll Cardiol. 1993 Apr;21(5):1039–1047. doi: 10.1016/0735-1097(93)90222-m. [DOI] [PubMed] [Google Scholar]
- Hirsh J. Heparin. N Engl J Med. 1991 May 30;324(22):1565–1574. doi: 10.1056/NEJM199105303242206. [DOI] [PubMed] [Google Scholar]
- Hsia J., Hamilton W. P., Kleiman N., Roberts R., Chaitman B. R., Ross A. M. A comparison between heparin and low-dose aspirin as adjunctive therapy with tissue plasminogen activator for acute myocardial infarction. Heparin-Aspirin Reperfusion Trial (HART) Investigators. N Engl J Med. 1990 Nov 22;323(21):1433–1437. doi: 10.1056/NEJM199011223232101. [DOI] [PubMed] [Google Scholar]
- Hsia J., Kleiman N., Aguirre F., Chaitman B. R., Roberts R., Ross A. M. Heparin-induced prolongation of partial thromboplastin time after thrombolysis: relation to coronary artery patency. HART Investigators. J Am Coll Cardiol. 1992 Jul;20(1):31–35. doi: 10.1016/0735-1097(92)90133-8. [DOI] [PubMed] [Google Scholar]
- Melandri G., Branzi A., Traini A. M., Semprini F., Cervi V., Magnani B. On the value of the activated clotting time for monitoring heparin therapy in acute coronary syndromes. Am J Cardiol. 1993 Feb 15;71(5):469–471. doi: 10.1016/0002-9149(93)90461-k. [DOI] [PubMed] [Google Scholar]
- Théroux P., Waters D., Lam J., Juneau M., McCans J. Reactivation of unstable angina after the discontinuation of heparin. N Engl J Med. 1992 Jul 16;327(3):141–145. doi: 10.1056/NEJM199207163270301. [DOI] [PubMed] [Google Scholar]
- Weitz J. I., Hudoba M., Massel D., Maraganore J., Hirsh J. Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin III-independent inhibitors. J Clin Invest. 1990 Aug;86(2):385–391. doi: 10.1172/JCI114723. [DOI] [PMC free article] [PubMed] [Google Scholar]