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 S Alpert

Research output: Contribution to journalArticle

61 Citations (Scopus)

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 - 1990
Externally publishedYes

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Antithrombin III
Nitroglycerin
Heparin
Partial Thromboplastin Time
Antigens
Coronary Care Units
Unstable Angina
Serum
Anticoagulants
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Intravenous nitroglycerin-induced heparin resistance : A qualitative antithrombin III abnormality. / Becker, Richard C.; Corrao, Jeanne M.; Bovill, Edwin G.; Gore, Joel M.; Baker, Stephen P.; Miller, Michael L.; Lucas, Fred V.; Alpert, Joseph S.

In: American Heart Journal, Vol. 119, No. 6, 1990, p. 1254-1261.

Research output: Contribution to journalArticle

Becker, RC, Corrao, JM, Bovill, EG, Gore, JM, Baker, SP, Miller, ML, Lucas, FV & Alpert, JS 1990, 'Intravenous nitroglycerin-induced heparin resistance: A qualitative antithrombin III abnormality', American Heart Journal, vol. 119, no. 6, pp. 1254-1261. https://doi.org/10.1016/S0002-8703(05)80172-3
Becker, Richard C. ; Corrao, Jeanne M. ; Bovill, Edwin G. ; Gore, Joel M. ; Baker, Stephen P. ; Miller, Michael L. ; Lucas, Fred V. ; Alpert, Joseph S. / Intravenous nitroglycerin-induced heparin resistance : A qualitative antithrombin III abnormality. In: American Heart Journal. 1990 ; Vol. 119, No. 6. pp. 1254-1261.
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