Monitoring of Enoxaparin Level Using Citrated Clotting Time during Percutaneous Coronary Intervention

OBJECTIVES: To evaluate the use of citrated clotting time (CCT) during percutaneous coronary intervention (PCI) in both emergent and elective scenarios and using intravenous (IV) or subcutaneous (SC) dosing. BACKGROUND: Monitoring of enoxaparin during PCI had limitations in the past due to lack of point-of-care testing. Introduction of the CCT enables the determination of the degree of anticoagulation by enoxaparin. METHODS AND RESULTS: An analysis on 51 consecutive patients revealed that after three SC doses (1 mg/kg twice a day) or a single IV bolus (1 mg/kg) of enoxaparin, the CCT was consistently in the therapeutic range of > or =260 seconds (475 +/- 105 and 565 +/- 151 sec, respectively). Patients who received < 3 SC doses of enoxaparin were subtherapeutic for PCI. A supplemental IV bolus of 0.3 mg/kg was found always to raise the CCT to therapeutic level (499 +/- 178 sec). CONCLUSIONS: Enoxaparin was found to be effective and safe during PCI with low vascular complication rate (9.3%). Patients who received < 3 SC doses of enoxaparin benefit most from using CCT monitoring. IV dosing consistently achieved adequate anticoagulation.