Monitoring prothrombin fragment 1+2 during initiation of oral anticoagulant therapy after intracoronary stenting

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Abstract
Patients with intracoronary stent implantation are treated with aggressive anticoagulant and antiplatelet therapy consisting of high-dose heparin, phenprocoumon, acetylsalicylic acid, dipyridamole, and the infusion of dextran to prevent a subacute thrombotic occlusion of the stented segment. In an effort to optimize this treatment by reducing both imminent bleeding complications and subacute thrombotic occlusion, the concentrations of prothrombin fragment 1+2 (F1+2) were determined after intracoronary Palmaz-Schatz stent implantation in 19 consecutive patients. The F1+2 concentrations after stent implantation and before the initiation of oral anticoagulant therapy (OAT) were 0.35 nm/l and 0.25–0.53 nm/l (median and 25th–75th percentile), versus 0.74 nm/l and 0.52–0.78 nm/l, in healthy subjects and 0.61 nm/l and 0.30–1.02 nm/l in 15 patients with ongoing proximal DVT. Nine days after initiation of OAT, F1+2 concentrations in both patient groups had not yet reached levels observed in patients with OAT in the stable state (0.16 nm/l, 0.12–0.26 nm/l;n=76;P<0.0001 compared with healthy subjects; INR 2.0–4.5). Despite an INR greater than 2.0, accompanying heparinization was terminated on day 9. In two stented patients a minor bleeding complication arose after the removal of the arterial catheter. Subacute thrombotic occlusions were not observed. Since F1+2 concentrations did not exceed the upper limit of normal range (1.11 nm/l) in any of the 19 patients, the therapeutic regimen was not changed. Monitoring F1+2 may thus be helpful in introducing a more individual treatment if aggressive anticoagulation has to be performed.