Intravenous nitroglycerin-induced heparin resistance: A qualitative antithrombin III abnormality

Richard C. Becker, Jeanne M. Corrao, Edwin G. Bovill, Joel M. Gore, Stephen P. Baker, Michael L. Miller, Fred V. Lucas, Joseph A. Alpert

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Abstract

An ability of intravenous nitroglycerin to interfere with the anticoagulant properties of intravenous heparin would have profound clinical implications. To investigate nitroglycerin-heparin interactions, the following pilot study was performed. Patients (N=18) admitted to the coronary care unit with a diagnosis of either acute myocardial infarction or unstable angina were divided into four treatment groups: (1) intravenous nitroglycerin and intravenous heparin; (2) intravenous nitroglycerin alone; (3) intravenous heparin alone; or (4) neither intravenous nitroglycerin nor intravenous heparin. Serial determinations of activated partial thromboplastin time (APTT), serum heparin concentration, antithrombin III (ATIII) antigen (ATA), and ATIII activity (ATC) were obtained over a 72-hour period. Overall, patients receiving intravenous nitroglycerin did not differ significantly from other patients in APTT, heparin dose, heparin concentration, ATA, ATC, or ATA/ATC ratio (ATR). However, patients receiving intravenous nitroglycerin at a rate exceeding 350 μg per minute had a lower APTT (p<0.05), lower ATC (p=0.02), higher ATR (p=0.004), and a larger heparin dose requirement than patients receiving lower infusion rates. ATR correlated directly (r=0.91; p<0.05) and ATC inversely (r=-0.78; p<0.05) with the intravenous nitroglycerin dose. Serum heparin concentration did not correlate with the intravenous nitroglycerin dose. Intravenous nitroglycerin-induced heparin resistance occurs at a critical nitroglycerin dose. A nitroglycerin-induced qualitative ATIII abnormality may be the underlying mechanism.

Original languageEnglish (US)
Pages (from-to)1254-1261
Number of pages8
JournalAmerican Heart Journal
Volume119
Issue number6
DOIs
StatePublished - Jun 1990

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Becker, R. C., Corrao, J. M., Bovill, E. G., Gore, J. M., Baker, S. P., Miller, M. L., Lucas, F. V., & Alpert, J. A. (1990). Intravenous nitroglycerin-induced heparin resistance: A qualitative antithrombin III abnormality. American Heart Journal, 119(6), 1254-1261. https://doi.org/10.1016/S0002-8703(05)80172-3