October 27, 2009Catheterization and Cardiovascular Interventions
Enoxaparin 0.3 mg/kg IV supplement for patients transitioning to PCI after subcutaneous enoxaparin therapy for NSTE ACS: A subgroup analysis from the SYNERGY trial
Why the study?
Does adherence to protocol-mandated supplemental IV enoxaparin dosing during PCI improve clinical and bleeding outcomes in patients with NSTE ACS?
Population
4,687 patients with non-ST-segment elevation acute coronary syndromes enrolled in the SYNERGY trial who…
Comparison
Subcutaneous enoxaparin with adherence to… vs Subcutaneous enoxaparin without adherence to…
Design
Cohort, Patients were originally randomized to unfractionated heparin or…
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Protocol adherence shows non-significant trends in NSTE ACS PCI; should not change practice and leaves open randomized confirmation of supplemental dosing.
Structured PICO
Does adherence to protocol-mandated supplemental IV enoxaparin dosing during PCI improve clinical and bleeding outcomes in patients with NSTE ACS?
P
Population
4,687 patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) enrolled in the SYNERGY trial who underwent percutaneous coronary intervention (PCI) during index hospitalization.
I
Intervention
Subcutaneous enoxaparin with adherence to protocol-mandated dosing (including a 0.3 mg/kg IV bolus immediately before PCI if balloon inflation occurred ≥ 8 hours after the last subcutaneous dose).
C
Comparator
Subcutaneous enoxaparin without adherence to protocol-mandated dosing (received inappropriate IV therapy, either before 8 hours or not receiving it after 8 hours).
O
Outcome
Composite of death or myocardial infarction (MI) post PCI and through 30 days.composite
Adherence to protocol-mandated supplemental IV enoxaparin dosing during delayed PCI in NSTE ACS patients shows a non-significant trend toward improved ischemic and bleeding outcomes.
Limitations
- Exploratory subgroup analysis
Cite This Study
Cohen et al. (2009) studied this question.