Usefulness of intravenous enoxaparin for percutaneous coronary intervention in stable angina pectoris

Rabah, Maher; Premmereur, Jerôme; Graham, Mariann; Fareed, Jawed; Hoppensteadt, Debra; Grines, Lorelie L; Grines, Cindy L.

doi:10.1016/s0002-9149(99)00582-2

Cited by 87 publications

(51 citation statements)

References 25 publications

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“…There are, however, limitations for the use of UFH; thus, other anticoagulants have been investigated, especially in adults undergoing coronary intervention. 619 In a pediatric study by Roschitz et al, 620 40 children received a 100 U/kg body weight bolus of UFH, administered after arterial or venous access, and 25 children were treated with 1 to 1.6 mg/kg enoxaparin subcutaneously. The prophylactic levels of anti-FXa activity were achieved in all patients at the end of catheterization.…”

Section: Thromboprophylaxis For Arterial and Venous Thrombosismentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

282

245

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Section: Thromboprophylaxis For Arterial and Venous Thrombosismentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

282

245

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“…These and other studies have also established the safety of upstream and periprocedural, subcutaneous enoxaparin as the primary antithrombotic agent for PCI in patients with non-ST elevation ACS (7)(8)(9). In the setting of elective PCI, intravenous enoxaparin also appears to be safe and efficacious (7,10,11). A pivotal trial comparing intravenous enoxaparin with UFH for elective PCI (the Safety and Efficacy of Enoxaparin in Percutaneous Coronary Intervention (12,13).…”

Section: Discussionmentioning

confidence: 99%

Catheter thrombosis during primary percutaneous coronary intervention for acute ST elevation myocardial infarction despite subcutaneous low-molecular-weight heparin, acetylsalicylic acid, clopidogrel and abciximab pretreatment

Buller

Pate

Armstrong

et al. 2006

Canadian Journal of Cardiology

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CE Buller, GE Pate, PW Armstrong, et al. Catheter thrombosis during primary percutaneous coronary intervention for acute ST elevation myocardial infarction despite subcutaneous low-molecular-weight heparin, acetylsalicylic acid, clopidogrel and abciximab pretreatment. Can J Cardiol 2006;22(6):511-515.BACKGROUND: Subcutaneous enoxaparin is increasingly employed as the antithrombin of choice in non-ST elevation myocardial infarction and in conjunction with various fibrinolytic regimens in acute ST elevation myocardial infarction (STEMI). Few data exist describing the use of subcutaneous or intravenous enoxaparin as an anticoagulant in the highly thrombotic setting of primary percutaneous coronary intervention (PCI) for STEMI. METHODS: The Which Early ST Elevation Therapy (WEST) study compared fibrinolysis (with and without early cardiac catheterization) with primary PCI in a setting that expedited both strategies on first medical contact. Patients assigned primary PCI are administered acetylsalicylic acid 325 mg, clopidogrel 300 mg and subcutaneous enoxaparin 1 mg/kg before transport to a PCI centre. Of 36 initial patients treated with primary PCI, three patients had procedures that were complicated by extensive thrombosis within coronary catheters and on PCI equipment. RESULTS: Index cases were men aged 43 to 68 years who presented with confirmed STEMI and angiographically proven acute total or subtotal occlusion of a major epicardial coronary segment. During PCI, performed 76 min to 102 min following enoxaparin administration, a clot developed within the guide catheter or on the coronary guidewires and balloon catheter shafts, thus necessitating the replacement of all PCI equipment. In one case, there was evidence of continued intracoronary clot propagation and embolization. CONCLUSION: A single, conventional, weight-adjusted dose of subcutaneous enoxaparin before expedited primary PCI for STEMI may not provide a reliable antithrombotic effect. Supplementary intravenous enoxaparin is now strongly recommended within the WEST study, and a substudy evaluating pre-and postprocedural antifactor Xa activity has been initiated.

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“…[2][3][4][5] There are not many studies on the effects and safety of LMWH during PCI, although it is known that LMWH are superior to UFH. [8][9][10][11] However, as mentioned above, because accurate measurement of anticoagulation is required and the anticoagulation state can be simply reflected by activated clotting time (ACT) measurement, LMWH use is still limited in many coronary laboratories, and furthermore, guidelines currently do not exist.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] Although there have been few studies on the therapeutic efficacy and safety of LMWH during percutaneous coronary intervention (PCI), it is known that the effect of LMWH is superior to that of UFH due to no intrinsic platelet activation and aggregation, and the favorable clinical results obtained. [8][9][10][11] Also, it is known that LMWH has a more effective and stable anticoagulation effect than UFH. The major reason is the superior bioavailability, and the minor causes are the decrease in nonspecific protein binding, and decreases in the responsiveness for neutralization by platelet factor 4 and easy control of release of von Willebrand factor.…”

mentioning

confidence: 99%

Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

et al. 2006

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SUMMARYThe purpose of this study was to determine the clinical outcomes of abciximab combined with the low molecular weight heparin (LMWH), dalteparin, in high-risk percutaneous coronary intervention (PCI) patients with acute myocardial infarction (AMI). A total of 140 high-risk PCI patients with AMI were divided into 2 groups: unfractionated heparin (UFH) with abciximab (group I: 70 patients, 58.7 ± 10.5 years), and dalteparin with abciximab (group II: 70 patients, 59.6 ± 9.8 years). Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined. Baseline clinical characteristics, laboratory findings, echocardiography parameters, and baseline angiographic characteristics were not different between the 2 groups. The incidence of thrombotic total occlusion lesions was 62.9% in both groups. Procedural success was achieved in 91.4% in group I and 90.0% in group II. Bleeding and hemorrhagic events were not different between the 2 groups. No significant intracranial bleeding was observed in either group. The incidence of in-hospital MACE was 7 (10.0%) in group I and 4 (5.7%) in group II. Four-year clinical follow-up was performed in 97% of the patients. Four years after PCI, death occurred in 6 (8.6%) patients in group I and in 7 (10.0%) in group II. MI occurred in 4 (5.7%) and 4 (5.7%), target vessel revascularization (TVR) in 23 (32.9%) and 16 (22.9%), and bypass surgery in 3 (4.3%) and 1 (1.4%), respectively. Overall, a MACE occurred in 33 (47.1%) patients in group I and in 26 (35.1%) patients in group II (P = 0.23). The long-term clinical outcome with dalteparin combined with abciximab may be comparable to that of UFH plus abciximab in high risk PCI patients with AMI. (Int Heart J 2006; 47: 821-831)

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Usefulness of intravenous enoxaparin for percutaneous coronary intervention in stable angina pectoris

Cited by 87 publications

References 25 publications

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Catheter thrombosis during primary percutaneous coronary intervention for acute ST elevation myocardial infarction despite subcutaneous low-molecular-weight heparin, acetylsalicylic acid, clopidogrel and abciximab pretreatment

Comparison of Abciximab Combined With Dalteparin or Unfractionated Heparin in High-Risk Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients

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