Heparin or enoxaparin anticoagulation for primary percutaneous coronary intervention
| Autor: | David Brieger, Nicolas Vignolles, Anne Bellemain-Appaix, Antoine Landivier, Olivier Barthelemy, Dominique Costagliola, Johanne Silvain, Gilles Montalescot, Anne Mercadier, Jean-Philippe Collet, Farzin Beygui, Rémi Choussat |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Paris medicine.medical_specialty Time Factors medicine.drug_class medicine.medical_treatment Myocardial Infarction Low molecular weight heparin Hemorrhage Risk Assessment Risk Factors Internal medicine Odds Ratio Secondary Prevention medicine Humans Radiology Nuclear Medicine and imaging Hospital Mortality Prospective Studies Registries Myocardial infarction Angioplasty Balloon Coronary Enoxaparin Propensity Score Aged Analysis of Variance Chi-Square Distribution Heparin business.industry ST elevation Anticoagulant Anticoagulants Percutaneous coronary intervention General Medicine Thrombolysis Middle Aged medicine.disease Logistic Models Treatment Outcome Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors TIMI |
| Zdroj: | Catheterization and Cardiovascular Interventions. 77:182-190 |
| ISSN: | 1522-1946 |
| Popis: | Objectives: The aim of this study was to compare efficacy and safety outcomes among patients receiving enoxaparin or unfractionated heparin (UFH) while undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background: Primary PCI (pPCI) for ST elevation has traditionally been supported by UFH. The low molecular weight heparin enoxaparin may provide better outcomes when used for pPCI. Methods: Consecutive eligible patients (580) undergoing pPCI enrolled in the prospective electronic Pitie-Salpetriere registry of ischemic coronary syndromes (e-PARIS) registry were grouped according to whether they received UFH or enoxaparin as the sole anticoagulant. Logistic regression modeling, propensity-weighted adjustment, and sensitivity analyses were used to evaluate efficacy and safety endpoints for enoxaparin vs. UFH. Results: Enoxaparin was administered to 346 patients and UFH to 234 without ACT or anti-Xa guided dose adjustment. PCI was performed through the radial artery in 90%, with frequent (75%) use of GPIIb/IIIa antagonists. Patients receiving enoxaparin were more likely to be therapeutically anticoagulated during the procedure (68% vs. 50%, P < 0.0001) and were less likely to experience death or recurrent myocardial infarction (MI) in hospital (adjusted OR 0.28 95% CI (0.12–0.68) or by 30 days (adjusted OR 0.35 95% CI 0.16–0.81). All cause mortality was also reduced in hospital (adjusted OR 0.32, 95% CI (0.12–0.85) and to 30 days (adjusted OR 0.40 95% CI 0.17–0.99). Other ischemic endpoints were similarly reduced with enoxaparin. Thrombolysis in myocardial infarction (TIMI) major bleeding events were numerically fewer among patients receiving enoxaparin (1.2% vs. 2.6%, P = 0.2). Conclusions: In patients with STEMI presenting for PCI, enoxaparin was associated with a reduction in all ischemic complications, more frequent therapeutic anticoagulation, and no increase in major bleeding when compared against unfractionated heparin. © 2010 Wiley-Liss, Inc. |
| Databáze: | OpenAIRE |
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