Key result
Higher anti-Xa levels during elective PCI were associated with increased non-CABG-related major and minor bleeding.
Why the study?
Does the level of anticoagulation with enoxaparin compared to unfractionated heparin impact ischaemic and bleeding outcomes in patients undergoing elective PCI?
Cohort
Does the level of anticoagulation with enoxaparin compared to unfractionated heparin impact ischaemic and bleeding outcomes in patients undergoing elective PCI?
Enoxaparin achieves target anticoagulation levels more reliably than UFH during elective PCI, with anti-Xa levels up to 0.9 IU/mL offering a favorable safety and efficacy profile.
Answers are grounded in this paper and cite their sources.
Supports caution with anti-Xa >0.9 IU/mL in elective PCI; leaves open optimal targets pending randomized trials.
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.
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Montalescot et al. (2008) conducted a cohort in Elective percutaneous coronary intervention. Increasing anti-Xa levels vs. Lower anti-Xa levels was evaluated on non-coronary artery bypass graft-related major and minor bleeding (OR 1.6, 95% CI 1.0-2.5, p=0.03). Higher anti-Xa levels during elective PCI were associated with increased non-CABG-related major and minor bleeding.
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