Primary percutaneous coronary intervention for ST-elevation myocardial infarction using an intravenous and subcutaneous enoxaparin low molecular weight heparin regimen

Khoobiar, Sargis; Mejevoi, Nicolai; Kaid, Khalil; Boiangiu, Catalin; Setty, Sampoornima; Tanwir, Anjum; Khalid, Khaula; Cohen, Marc

doi:10.1007/s11239-008-0258-2

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…Three studies of PCI after fibrinolysis resulted in favorable outcome when enoxaparin was compared with UFH (LOE 4 397,432 ; LOE 5 394 ). Eight other studies showed no benefit using enoxaparin compared with UFH (LOE 2 342,433,434 ; LOE 4 405,409,435,436 ; LOE 5 345 ).…”

Section: Consensus On Sciencementioning

confidence: 97%

“…Four randomized, controlled trials (RCTs, LOE 1), 330 -332,333 3 meta-analyses (LOE 1), 334 -336 6 nonrandomized control trials (LOE 2 to 4), [337][338][339][340][341][342][343][344] and 5 additional studies (LOE 4 to 5) [345][346][347][348][349] did not demonstrate a difference for outcomes among in-hospital patients given enoxaparin compared with UFH.…”

Section: Consensus On Sciencementioning

confidence: 99%

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Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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Section: Consensus On Sciencementioning

confidence: 97%

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

View full text Add to dashboard Cite

show abstract

“…9,13,14 However, most of these studies used enoxaparin as an adjunctive antithrombin therapy to thrombolysis, and very limited data to date are available about the comparison of enoxaparin versus UFH in patients with primary PCI. 15,16 In addition, although the recent OASIS 6 trial 17 showed that fondaparinux significantly reduced the risk of death, recurrent MI, and severe bleeds as an adjunct to thrombolytic therapy, the results of antithrombotic agents with fibrinolytics cannot be translated to primary PCI.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, an observational study 15 has evaluated the safety and efficacy of combination of intravenous and subcutaneous enoxaparin as compared with intravenous UFH in 83 STEMI patients undergoing primary PCI. Because of the limited case number, this study showed that there was no difference in the rate of mortality, MACE, or major bleeding between these 2 regimens.…”

Section: Discussionmentioning

confidence: 99%

Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents

Rha

Chen

et al. 2010

American Heart Journal

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“…Moreover, there was no increase in bleeding in the enoxaparin cohort compared with the unfractionated heparin cohort in ExTRACT TIMI 25 PCI. A recent single center report also demonstrated excellent results with the use of this combined SC and IV enoxaparin regimen in comparison with unfractionated heparin in patients undergoing primary PCI [11]. Although the mean time to PCI in ExTRACT TIMI 25 was over 100 h, the need for some ST-elevation myocardial infarction patients initially treated with thrombolysis to undergo more rapid rescue PCI highlights the need to better understand the pharmacodynamics in the first several hours after initiating this enoxaparin regimen.…”

Section: Discussionmentioning

confidence: 96%

The pharmacodynamics of enoxaparin in percutaneous coronary intervention with precise rapid enoxaparin loading (PEPCI-PRE study)

Martin

Fry

Martin

et al. 2009

J Thromb Thrombolysis

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Primary percutaneous coronary intervention for ST-elevation myocardial infarction using an intravenous and subcutaneous enoxaparin low molecular weight heparin regimen

Abstract: Application of IV + SC enoxaparin strategy for primary PCI in STEMI appears both safe and efficacious. A prospective randomized trial will be necessary to evaluate the safety and efficacy more thoroughly.

Cited by 9 publications

References 16 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

Low-molecular-weight heparin versus unfractionated heparin in acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents

The pharmacodynamics of enoxaparin in percutaneous coronary intervention with precise rapid enoxaparin loading (PEPCI-PRE study)

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