Prolonged enoxaparin therapy compared with standard-of-care antithrombotic therapy in opiate-treated patients undergoing primary percutaneous coronary intervention

Abstract

A novel enoxaparin regimen consisting of intra-arterial bolus (0.75 mg/kg) followed by intravenous infusion (0.75 mg/kg/6 hours) has been developed as a possible solution to the delayed absorption of oral P2Y 12 inhibitors in opiate-treated ST-elevation myocardial infarction (STEMI) patients undergoing primary angioplasty. We aimed to study the feasibility of this regimen as an alternative to standard-of-care treatment (SOC) with unfractionated heparin ± glycoprotein IIb/IIIa antagonist (GPI). One hundred opiate-treated patients presenting with STEMI and accepted for primary angioplasty were randomized (1:1) to either enoxaparin or SOC. Fifty patients were allocated enoxaparin (median age 61, 40% females) and 49 allocated SOC (median age 62, 22% females). One developed stroke before angiography and was withdrawn. One SOC patient had a gastrointestinal bleed resulting in 1 g drop in hemoglobin and early cessation of GPI infusion. Two enoxaparin patients had transient minor bleeding: one transient gingival bleed and one episode of coffee ground vomit with no hemoglobin drop or hemodynamic instability. Two SOC and no enoxaparin group patients had acute stent thrombosis. These preliminary data support further study of this novel 6-hour enoxaparin regimen in opiate-treated PPCI patients.

The Interplay between Non-Esterified Fatty Acids and Plasma Zinc and Its Influence on Thrombotic Risk in Obesity and Type 2 Diabetes

“…Both these aspects of coagulation are altered in obesity and T2DM; platelets display hyperactivity, while coagulation proteins circulate at higher concentrations and display enhanced activation, ultimately leading to the formation of compact fibrin networks and impaired fibrinolysis [ 5 , 6 ]. Hypofibrinolysis also represents a key abnormality in obese and diabetic patients and contributes to the adverse clinical outcome in this population [ 7 , 8 ].…”

Ticagrelor: clinical development and future potential

“…This effect is particularly important to consider when aspirin and an oral P2Y 12 inhibitor such as ticagrelor are required to prevent acute stent thrombosis, with potentially catastrophic consequences [81][82][83]. In these patients, administration of a parenteral antithrombotic drug to cover the delayed absorption may reduce the risk of acute stent thrombosis, such as a 6-hour infusion of the glycoprotein IIb/IIIa antagonist tirofiban [84], the low-molecularweight heparin enoxaparin [85,86] or the intravenous P2Y 12 inhibitor cangrelor [87].…”