Key result
An antithrombotic regimen of nadroparin with unfractionated heparin during the procedure resulted in major hemorrhage in 1.3% of patients undergoing PCI and 1.4% of those undergoing angiography alone.
An antithrombotic regimen of unfractionated heparin during PCI, preceded and followed by subcutaneous nadroparin, is well-tolerated with low rates of major hemorrhage in patients with non-ST elevation ACS.
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Supports tolerability of nadroparin plus heparin in NSTE-ACS; hypothesis-generating and should not yet change practice.
BACKGROUND: Nadroparin, a low-molecular-weight heparin (LMWH), is an alternative to unfractionated heparin for the acute management of patients with non-ST elevation acute coronary syndrome (ACS): unstable angina or non-Q-wave myocardial infarction. However, unfractionated heparin can be substituted for LMWH in patients requiring percutaneous coronary interventions (PCIs) for the duration of the procedure. The tolerability of this anti-thrombotic regimen (i.e. unfractionated heparin for the duration of PCIs, preceded and followed by subcutaneous injection of nadroparin) is not yet documented. DESIGN AND METHODS: This open-label 6-day study was carried out in 302 patients to test the tolerability of this anti-thrombotic regimen in patients requiring PCIs. The primary end-point of the study was the incidence of major haemorrhage over the whole study duration (6 days). The secondary end-point was the need for transfusion and vascular repair after PCI. RESULTS: The incidence of major haemorrhage in patients undergoing coronary angiography (CA) without or with PCIs was 1.4% and 1.3%, respectively, and the incidence of minor haemorrhage was 10.7% and 23.5%, respectively. These results are consistent with published data. CONCLUSIONS: These results suggest that CA and PCIs can be performed safely in patients being treated for unstable angina or non-Q-wave myocardial infarction receiving nadroparin pre- and post-coronary procedure and/or intervention, substituted by unfractionated heparin for the duration of the intervention.
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Bassand et al. (2003) studied Unstable angina or non-Q-wave myocardial infarction (n=302). Nadroparin pre- and post-procedure with unfractionated heparin during the procedure vs. Coronary angiography without PCI was evaluated on Incidence of major haemorrhage over the whole study duration (6 days). An antithrombotic regimen of nadroparin with unfractionated heparin during the procedure resulted in major hemorrhage in 1.3% of patients undergoing PCI and 1.4% of those undergoing angiography alone.
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