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

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 VII:c (−3.0%; P = .01), D-dimer (−44.0 ng/mL; P = .002), and thrombin-antithrombin complex (−0.7 μg/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 VII:c: −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 μg/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. (Am Heart J 2002;143:e3.)