Low molecular weight heparin (bemiparin sodium) and the coagulation profile of patients with heart failure.

ABSTRACT

BACKGROUND: Congestive heart failure (CHF) is associated with a hypercoagulable state. PATIENTS AND METHODS: A single-center, randomized, double-blind, placebo-controlled trial was performed to test the hypothesis that a prophylactic dose of low molecular weight heparin (bemiparin sodium 3500 IU/daily subcutaneously) will modify a hypercoagulable state in CHF. This study included 100 patients with CHF (New York Heart Association classification II to IV). All patients underwent 3 blood tests, at baseline (before randomization), 24 hours after randomization, and before hospital discharge or within 10 days from randomization. RESULTS: In comparison of baseline bemiparin sodium 3500 IU/daily subcutaneously with after 24 hours, there was a significant decrease in plasma levels of D-dimer (-13.8 ng/mL; P =.01) and prothrombin fragments 1 and 2 (-0.11 nmol/L; P =.01), whereas protein C was significantly increased (+3.5%; P =.03). In comparison of baseline bemiparin sodium 3500 IU/daily subcutaneously with after 4 to 10 days of therapy, there were significantly decreased plasma levels for factor VIIc (-3.0%; P =.01), D-dimer (-44.0 ng/mL; P =.002), and thrombin-antithrombin complex (-0.7 microg/L; P =.0001), whereas protein C was significantly increased (+16.0%; P =.03). On the other hand, in the group of patients treated with placebo after 24 hours, a significant decrease was observed of protein C (-4.0%; P =.04). After 24 hours, the changes from baseline were significantly different for some of the hemostatic factors in comparison of bemiparin sodium 3500 IU/daily and placebo (factor VIIc -1.7 versus 0.0%; P =.04; D-dimer -14 versus +24.3 ng/mL; P =.009; prothrombin fragments 1 and 2 -0.11 versus +0.11 nmol/L; P =.01; protein C +3.5 versus -4.0%; P =.01). Also at discharge, the changes from baseline were different for some of the markers in comparison of bemiparin sodium with placebo (D-dimer -44 versus 3.8 ng/mL; P =.002; thrombin-antithrombin complex -0.70 versus +0.14 microg/L; P =.002; protein C +16.0 versus +0.5%; P =.02). CONCLUSION: Our findings suggest that a hypercoagulable state in heart failure can be modified with bemiparin sodium therapy.