Abstract:
:Thrombosis occurs in 37% of children with acute lymphoblastic leukaemia (ALL) and is related to an L-asparaginase-induced acquired antithrombin (AT) deficiency. The incidence dictates the need for anticoagulant prophylaxis. Direct thrombin inhibitors (DTI) are independent of AT for effect and may thus have advantages in this population. The objective of this study was to determine the interaction of an AT deficiency with the anticoagulant effects of a DTI and a low molecular weight heparin (LMWH). Plasma samples from children with ALL were pooled (mean AT 0.53 U/ml). LMWH 0.3 and 0.7 U/ml or melagatran 0.3 and 0.5 micromol/l were added to the pools, then divided and AT was added back to one aliquot. In additional experiments, AT was added to AT immuno-depleted plasma. Endogenous thrombin generation capacity (ETGC) was assessed by the continuous method. In plasma with LMWH, there was a 66-88% decrease in ETGC in AT-normalised samples compared with neat. Conversely, no significant difference in ETGC with or without AT added for melagatran was seen. Experiments with AT-depleted plasma showed no effect of AT level on anticoagulant activity of DTI, but a significant relationship for LMWH. By contrast to LMWH, DTI provides a consistent anticoagulant response independent of AT levels in children with AT deficiency.
journal_name
Br J Haematoljournal_title
British journal of haematologyauthors
Kuhle S,Lau A,Bajzar L,Vegh P,Halton J,Cherrick I,Anderson R,Desai S,McCusker P,Wu J,Abshire T,Mahoney D,Mitchell Ldoi
10.1111/j.1365-2141.2006.06209.xsubject
Has Abstractpub_date
2006-09-01 00:00:00pages
526-31issue
5eissn
0007-1048issn
1365-2141pii
BJH6209journal_volume
134pub_type
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