Enoxaparin Anticoagulation Monitoring in the Catheterization Laboratory Using a New Bedside Test

Silvain, Jean‐François; Beygui, Farzin; Ankri, Annick; Bellemain-Appaix, Anne; Peña, Ana; Barthélémy, Olivier; Cayla, Guillaume; Gallois, Vanessa; Galier, Sophie; Costagliola, Dominique; Collet, Jean‐Philippe; Montalescot, Gilles

doi:10.1016/j.jacc.2009.08.077

Cited by 22 publications

(15 citation statements)

References 19 publications

(18 reference statements)

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“…While significant variability in sensitivity between different coagulation methods (clot-based, chromogenic, and point-of-care) have been reported [3,27,28] significant differences often arise even when the method of testing is identical but the manufacturer of the test kit differs.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the anticoagulant response of a novel fluorogenic anti-FXa assay with two commercial anti-FXa chromogenic assays

Harris

O’Brien

Castro-López

et al. 2011

Thrombosis Research

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Section: Discussionmentioning

confidence: 99%

Comparison of the anticoagulant response of a novel fluorogenic anti-FXa assay with two commercial anti-FXa chromogenic assays

Harris

O’Brien

Castro-López

et al. 2011

Thrombosis Research

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“…10 Another study used Hemonox-CT to identify patients with an insufficient anti-Xa activity level (Ͻ0.5 U/mL) among 296 patients undergoing PCI. 59 Hemonox-CT, aPTT, and chromogenic anti-Xa activity levels were measured at baseline and 10 minutes after IV administration of enoxaparin. A Hemonox-CT threshold value of 120 seconds was associated with 94% sensitivity, 73% specificity, 74% positive predictive value, and 95% negative predictive value.…”

Section: Act and Lmwhmentioning

confidence: 99%

Point-of-Care Testing for Anticoagulation Monitoring in Neuroendovascular Procedures

Hussein

Georgiadis

Qureshi

2011

AJNR Am J Neuroradiol

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SUMMARY: POC testing is defined as diagnostic testing at or near the site of patient care. Rapid measurement of the intensity of anticoagulation and, more recently, platelet inhibition allows dose titration of adjuvant medications such a heparin and antiplatelet agents during neuroendovascular procedures. However, knowledge among practicing physicians regarding the pathophysiologic basis of these measurements and variations in knowledge about the differences among devices is often limited. This review discusses the role of anticoagulation in endovascular procedures and the currently available POC tests for anticoagulation monitoring. ABBREVIATIONS:ACT ϭ activated clotting time; Anti-Xa ϭ quantitative chromogenic heparin assay; aPTT ϭ activated partial thromboplastin time; AT ϭ antithrombin; CI ϭ confidence interval; GP IIb/IIIa ϭ glycoprotein IIb/IIIa; Hemonox-CT ϭ Hemonox clotting time; HIT ϭ heparin-induced thrombocytopenia; HMT ϭ Heparin Management Test; IV ϭ intravenous; LMWH ϭ low-molecularweight heparin; MI ϭ myocardial infarction; OR ϭ odds ratio; PCI ϭ percutaneous coronary intervention; POC ϭ point of care; UFH ϭ unfractionated heparin T hromboembolism ensues from activation of platelets and the coagulation cascade and is a major source of complications during endovascular procedures. Multiple studies have demonstrated accelerated platelet activation during coronary and cerebral angioplasty.1,2 The coagulation cascade (Fig 1) consists of a sequential conversion of a series of proenzymes, or inactive precursor proteins (zymogens) to active enzymes, resulting in the formation of thrombus. It can be divided into 3 pathways: the extrinsic pathway (tissue factor and factor VIIa), which is the primary activator of the cascade; the intrinsic pathway (factors XIIa, XIa, IXa, and VIIIa), which amplifies the cascade; and the common pathway (factor Xa, factor Va, and thrombin), which generates thrombin and fibrin.Vessel injury and the introduction of foreign bodies set off the coagulation cascade.3 Catheters and wires used in endovascular procedures are thrombogenic, independent of intimal injury.3 Traversing atherosclerotic lesions with guidewires and catheters can dislodge plaque or thrombus. Inflation of balloons can produce intimal cracks, flaps, or dissections, all of which act as thrombogenic surfaces.3 In vivo studies have demonstrated that platelets rapidly accumulate on the stent surface after placement, especially if the underlying artery is injured. 4 The role of fibrin and platelets in stent-related thrombosis has been confirmed in pathologic studies. 5Anticoagulants and antiplatelet agents are, therefore, essential for reducing the rate of thromboembolic complications. On the other hand, their use may increase the risk of bleeding complications. In this review, we will focus on anticoagulants and available POC devices that measure anticoagulation. Brief Overview of Anticoagulant MedicationsAnticoagulants reduce the activity of proteases in the coagulation cascade. On the basis of their mechanism of ac...

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“…Low molecular weight heparins (LMWHs) are a group of anticoagulant drugs that are used in the treatment of venous thrombosis, cardiovascular disease, thrombotic and ischaemic stroke worldwide [1,2]. A significant advantage of LMWHs over unfractionated heparin (UFH) is the fact that monitoring in the large majority of patients is not essential.…”

Section: Introductionmentioning

confidence: 99%

“…Some of the standard coagulation monitoring assays such as the activated partial thromboplastin time test (APTT) or the activated clotting time test (ACT) are not sufficiently discriminatory for monitoring LMWHs, suffer from inter-laboratory variability and are lacking in standardization [2,7,8]. LMWHs exert their anticoagulant effect via interaction with the pentasaccharide-binding domain on antithrombin (AT), which in turn enhances the inhibitory effect of AT on factor Xa (FXa) [9].…”

Section: Introductionmentioning

confidence: 99%

Comparison of a fluorogenic anti-FXa assay with a central laboratory chromogenic anti-FXa assay for measuring LMWH activity in patient plasmas

Harris

Castro-López

Jenkins

et al. 2011

Thrombosis Research

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Enoxaparin Anticoagulation Monitoring in the Catheterization Laboratory Using a New Bedside Test

Abstract: Hemonox CT appears to be a fast and reliable bedside test for detecting patients insufficiently anticoagulated and needing adjustment of anticoagulation therapy with enoxaparin before PCI.

Cited by 22 publications

References 19 publications

Comparison of the anticoagulant response of a novel fluorogenic anti-FXa assay with two commercial anti-FXa chromogenic assays

Comparison of the anticoagulant response of a novel fluorogenic anti-FXa assay with two commercial anti-FXa chromogenic assays

Point-of-Care Testing for Anticoagulation Monitoring in Neuroendovascular Procedures

Comparison of a fluorogenic anti-FXa assay with a central laboratory chromogenic anti-FXa assay for measuring LMWH activity in patient plasmas

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