Heparins: A Shift of Paradigm
Heparins inhibit the thrombin forming capacity of plasma, i. e., the endogenous thrombin potential (ETP), by their anti-thrombin (aIIa) activity, the anti-factor Xa (aXa) activity is of minimal importance. This holds for both unfractionated heparin (UFH) and low molecular weight heparin (LMWH) at aX...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-11-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2019.00254/full |
| _version_ | 1819025077293809664 |
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| author | H. Coenraad Hemker Raed Al Dieri Suzette Béguin |
| author_facet | H. Coenraad Hemker Raed Al Dieri Suzette Béguin |
| author_sort | H. Coenraad Hemker |
| collection | DOAJ |
| description | Heparins inhibit the thrombin forming capacity of plasma, i. e., the endogenous thrombin potential (ETP), by their anti-thrombin (aIIa) activity, the anti-factor Xa (aXa) activity is of minimal importance. This holds for both unfractionated heparin (UFH) and low molecular weight heparin (LMWH) at aXa/aIIa ratios < 25. Clinical experience and epidemiological evidence show a direct relationship between the ETP and the risk of thrombosis and bleeding. Consequently, the therapeutic potency of a heparin is determined by its aIIa activity, i.e., the concentration of a domain in which 12 sugar flank the high affinity antithrombin-binding pentasaccharide (HA5) at one side. The response of individual plasmas to a fixed dose of any heparin is highly variable. This suggests that individualization of heparin dosage, on basis of the ETP, might reduce bleeding or re-thrombosis. There exist simple laboratory methods for both the ETP and the concentration of the active domain. These methods can be used both for unequivocally characterization of a heparin preparation and for controlling heparin therapy and allow arbitrary units relative to a standard to be abandoned. These tests are as robust as any hematological routine test but not yet routinely available, which severely encumbers progress in the field. |
| first_indexed | 2024-12-21T05:04:57Z |
| format | Article |
| id | doaj.art-5790160a584149a9b945ee95128a3e6f |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-21T05:04:57Z |
| publishDate | 2019-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-5790160a584149a9b945ee95128a3e6f2022-12-21T19:15:09ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2019-11-01610.3389/fmed.2019.00254425675Heparins: A Shift of ParadigmH. Coenraad HemkerRaed Al DieriSuzette BéguinHeparins inhibit the thrombin forming capacity of plasma, i. e., the endogenous thrombin potential (ETP), by their anti-thrombin (aIIa) activity, the anti-factor Xa (aXa) activity is of minimal importance. This holds for both unfractionated heparin (UFH) and low molecular weight heparin (LMWH) at aXa/aIIa ratios < 25. Clinical experience and epidemiological evidence show a direct relationship between the ETP and the risk of thrombosis and bleeding. Consequently, the therapeutic potency of a heparin is determined by its aIIa activity, i.e., the concentration of a domain in which 12 sugar flank the high affinity antithrombin-binding pentasaccharide (HA5) at one side. The response of individual plasmas to a fixed dose of any heparin is highly variable. This suggests that individualization of heparin dosage, on basis of the ETP, might reduce bleeding or re-thrombosis. There exist simple laboratory methods for both the ETP and the concentration of the active domain. These methods can be used both for unequivocally characterization of a heparin preparation and for controlling heparin therapy and allow arbitrary units relative to a standard to be abandoned. These tests are as robust as any hematological routine test but not yet routinely available, which severely encumbers progress in the field.https://www.frontiersin.org/article/10.3389/fmed.2019.00254/fullheparinlow molecular weight heparin (LMWH)thrombin generationendogenous thrombin potential (ETP)anti-thrombin activityanti-factor Xa activity |
| spellingShingle | H. Coenraad Hemker Raed Al Dieri Suzette Béguin Heparins: A Shift of Paradigm Frontiers in Medicine heparin low molecular weight heparin (LMWH) thrombin generation endogenous thrombin potential (ETP) anti-thrombin activity anti-factor Xa activity |
| title | Heparins: A Shift of Paradigm |
| title_full | Heparins: A Shift of Paradigm |
| title_fullStr | Heparins: A Shift of Paradigm |
| title_full_unstemmed | Heparins: A Shift of Paradigm |
| title_short | Heparins: A Shift of Paradigm |
| title_sort | heparins a shift of paradigm |
| topic | heparin low molecular weight heparin (LMWH) thrombin generation endogenous thrombin potential (ETP) anti-thrombin activity anti-factor Xa activity |
| url | https://www.frontiersin.org/article/10.3389/fmed.2019.00254/full |
| work_keys_str_mv | AT hcoenraadhemker heparinsashiftofparadigm AT raedaldieri heparinsashiftofparadigm AT suzettebeguin heparinsashiftofparadigm |