In an attempt to see whether the presence of different heparins affected the determination of protein C activity (APC),this parameter was measured before and during treatment in 23 deep vein thrombosis patients that had been randomly treated with 3 different LMWH (Choay CY-216 and CY-222 and Kabi-2165) and UFH,for 10 days, Very low levels of APC (amidolytic assay that uses thrombin-thrombomodulin to activate the barium citrate eluted PC) were found in those patients receiving UFH and having an APTT more than 3 times that of control, as well as in those patients receiving LMWH CY-216 and having an APTT of only 8 to 10 seconds higher than that of control plasma, In patients receiving CY-222 and Kabi-2165, no significant differences were observed between APC levels before and during treatment, PC antigen (ELISA assay) was normal in all cases, In order to see if these low APC levels were due to interference of heparin with the assay and at which doses, control plasma pool was supplemented "in vitro" with 0 to 2.5 IU/ml (0 to 0,00252) of UFH and with 0 to 3 anti-Xa U/ml of LMWH CY-216, APTT, PCAg, APC and presence of ATI 11 in the barium citrate eluates (immunodiffusion), were determined in all plasma samples before and after treatment with protamine sulphate (PS) at 0,0032, The results showed that UFH, when not neutralized with PS, resulted in low APC values only at doses higher than 0,8 IU/ml, corresponding to an APTT of more than 3 times that of control plasma, LMWH CY-216 at doses above 1 anti-XaU/ml, corresponding to an APTT of only 10 seconds higher than that of control, also produced a gradual decrease in APC values, ATI 11 was clearly visualized in the barium citrate eluates of all those plasma samples having a low APC value, The addition of PS to all samples containing UFH resulted in a complete normalization of APC values, with almost normal AFTT values and disappearance of ATI 11 from the barium citrate eluates, On the contrary, addition of PS to plasma containing CY-216 resulted in low APC values and presence of ATI 11 in the eluates of those samples containing more than 4 antiXaU/ml, whose APTT still was about 10 seconds above that of control.It is concluded that at therapeutic doses not only UFH but also LMWH CY-216 interfere with the APC assay, probably through binding of hepar in-ATI 11 complexes to barium citrate and neutralization of the thrombin used to activate the barium citrate eluted PC, LMWH CY-222 and Kabi-2165, although increasing the APTT similarly to CY-216, do not seem to interfere with the APC assay, Protamine sulphate, at 0,0032 in plasma, completely abolishes the effect of UFH on APC assay but not that of LMWH CY-216, More studies are being performed to see if higher doses of PS can be used to neutralize the effect of this LMWH.
Fasting Plasma Total Homocysteine Levels and Mortality and Allograft Loss in Kidney Transplant Recipients: A Prospective Study