TY - JOUR
T1 - Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention
T2 - Insights from the STEEPLE trial
AU - Montalescot, Gilles
AU - Cohen, Marc
AU - Salette, Genevieve
AU - Desmet, Walter J.
AU - Macaya, Carlos
AU - Aylward, Philip E.G.
AU - Steg, Ph Gabriel
AU - White, Harvey D.
AU - Gallo, Richard
AU - Steinhubl, Steven R.
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2008/2
Y1 - 2008/2
N2 - Aims: To determine the relationship between anticoagulation levels during percutaneous coronary intervention, and ischaemic events and bleeding. Methods and results: A sub-analysis from the STEEPLE trial was conducted. Pre-defined target anticoagulation levels were achieved in 86% of patients receiving enoxaparin, compared with 20% receiving unfractionated heparin (UFH) (P < 0.001). A significant relationship was observed between anti-Xa levels > 0.9 IU/mL and covariate-adjusted rate of non-coronary artery bypass graft-related major and minor bleeding [odds ratio (OR) 1.6, 95% CI 1.0-2.5 for each unit of anti-Xa; P = 0.03]; anti-Xa levels and covariate-adjusted incidence of death, myocardial infarction, or revascularization showed no significance (P = 0.47). Major bleeding increased significantly with an activated clotting time (ACT) > 325 s (OR 1.6, 95% CI 1.1-2.2 per 100 s; P = 0.04). A significant relationship with increasing ischaemic events was observed when ACT was < 325 s (OR 0.7, 95% CI 0.2-0.8 per 100 s; P = 0.006) indicating a narrow therapeutic window. Conclusion: Target anticoagulation levels were achieved more readily in patients receiving enoxaparin. An anti-Xa level of up to 0.9 IU/mL has a good safety and efficacy profile; poor achievement of target ACT with UFH makes assessing the optimal range difficult.
AB - Aims: To determine the relationship between anticoagulation levels during percutaneous coronary intervention, and ischaemic events and bleeding. Methods and results: A sub-analysis from the STEEPLE trial was conducted. Pre-defined target anticoagulation levels were achieved in 86% of patients receiving enoxaparin, compared with 20% receiving unfractionated heparin (UFH) (P < 0.001). A significant relationship was observed between anti-Xa levels > 0.9 IU/mL and covariate-adjusted rate of non-coronary artery bypass graft-related major and minor bleeding [odds ratio (OR) 1.6, 95% CI 1.0-2.5 for each unit of anti-Xa; P = 0.03]; anti-Xa levels and covariate-adjusted incidence of death, myocardial infarction, or revascularization showed no significance (P = 0.47). Major bleeding increased significantly with an activated clotting time (ACT) > 325 s (OR 1.6, 95% CI 1.1-2.2 per 100 s; P = 0.04). A significant relationship with increasing ischaemic events was observed when ACT was < 325 s (OR 0.7, 95% CI 0.2-0.8 per 100 s; P = 0.006) indicating a narrow therapeutic window. Conclusion: Target anticoagulation levels were achieved more readily in patients receiving enoxaparin. An anti-Xa level of up to 0.9 IU/mL has a good safety and efficacy profile; poor achievement of target ACT with UFH makes assessing the optimal range difficult.
KW - Anticoagulation
KW - Enoxaparin
KW - Percutaneous coronary intervention
KW - Unfractionated heparin
UR - http://www.scopus.com/inward/record.url?scp=39349094894&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehn008
DO - 10.1093/eurheartj/ehn008
M3 - Article
C2 - 18276619
AN - SCOPUS:39349094894
SN - 0195-668X
VL - 29
SP - 462
EP - 471
JO - European heart journal
JF - European heart journal
IS - 4
ER -