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Anticoagulation after subcutaneous enoxaparin is time sensitive in STEMI patients treated with tenecteplase.

Publication ,  Journal Article
Welsh, RC; Westerhout, CM; Buller, CE; O'Neill, B; Gordon, P; Armstrong, PW
Published in: J Thromb Thrombolysis
July 2012

The adequacy of anticoagulation with enoxaparin as an adjuvant to fibrinolytic therapy for STEMI is unclear and has implications for both efficacy and safety; especially in patients undergoing a pharmacoinvasive reperfusion strategy. A subset of fibrinolytic-treated patients in the WEST study was enrolled in a systematic anti-Xa substudy. All received ASA and subcutaneous (SQ) enoxaparin 1 mg/kg followed by TNK-tPA. Incremental IV dosing of enoxaparin (0.3-0.5 mg/kg) was allowed prior to percutaneous coronary intervention (PCI). Anti-Xa blood samples were drawn prior and after angiography. Data are presented as percentages, medians and IQRs. Forty-five patients underwent angiography 2.8 h (2.5-14.6) after fibrinolytic. The pre-angiography median anti-Xa acquired 179 min (153-875) after SQ enoxaparin was 0.48 U/ml (0.42-0.65); a relationship between anti-Xa activity and time from administration was evident (r = 0.418, p < 0.007). Without supplemental IV enoxaparin the 2nd anti-Xa acquired 218 min (195-930) after SQ enoxaparin was 0.48 U/ml (0.41-0.80, n = 29). After supplemental IV enoxaparin, the 2nd anti-Xa was 0.92 U/ml (0.72-1.10, n = 16). An incremental IV enoxaparin dose and anti-Xa relationship was demonstrated (r = 0.59, p = 0.001) i.e. no IV 0.48 U/ml (0.41-0.80, n = 29), 0.3 mg/kg IV 0.81 U/ml (0.63-1.00, n = 12), and 0.5 mg/kg IV 1.34 U/ml (1.16-1.54, n = 4). Most fibrinolytic treated STEMI patients receiving weight-adjusted SQ enoxaparin (1 mg/kg) had subtherapeutic anti-Xa levels (<0.5 U/ml) after ~3 h. A strategy of supplemental 0.3 mg/kg IV enoxaparin at time of PCI reliably achieved anti-Xa ≥ 0.5 U/ml. Our findings provide a rational novel strategy for anti-thrombotic management in STEMI patients undergoing a pharmacoinvasive reperfusion strategy.

Duke Scholars

Published In

J Thromb Thrombolysis

DOI

EISSN

1573-742X

Publication Date

July 2012

Volume

34

Issue

1

Start / End Page

126 / 131

Location

Netherlands

Related Subject Headings

  • Tissue Plasminogen Activator
  • Time Factors
  • Tenecteplase
  • Preoperative Care
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Subcutaneous
  • Humans
  • Fibrinolytic Agents
 

Citation

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Welsh, R. C., Westerhout, C. M., Buller, C. E., O’Neill, B., Gordon, P., & Armstrong, P. W. (2012). Anticoagulation after subcutaneous enoxaparin is time sensitive in STEMI patients treated with tenecteplase. J Thromb Thrombolysis, 34(1), 126–131. https://doi.org/10.1007/s11239-012-0697-7
Welsh, Robert C., Cynthia M. Westerhout, Christopher E. Buller, Blair O’Neill, Phillip Gordon, and Paul W. Armstrong. “Anticoagulation after subcutaneous enoxaparin is time sensitive in STEMI patients treated with tenecteplase.J Thromb Thrombolysis 34, no. 1 (July 2012): 126–31. https://doi.org/10.1007/s11239-012-0697-7.
Welsh RC, Westerhout CM, Buller CE, O’Neill B, Gordon P, Armstrong PW. Anticoagulation after subcutaneous enoxaparin is time sensitive in STEMI patients treated with tenecteplase. J Thromb Thrombolysis. 2012 Jul;34(1):126–31.
Welsh, Robert C., et al. “Anticoagulation after subcutaneous enoxaparin is time sensitive in STEMI patients treated with tenecteplase.J Thromb Thrombolysis, vol. 34, no. 1, July 2012, pp. 126–31. Pubmed, doi:10.1007/s11239-012-0697-7.
Welsh RC, Westerhout CM, Buller CE, O’Neill B, Gordon P, Armstrong PW. Anticoagulation after subcutaneous enoxaparin is time sensitive in STEMI patients treated with tenecteplase. J Thromb Thrombolysis. 2012 Jul;34(1):126–131.
Journal cover image

Published In

J Thromb Thrombolysis

DOI

EISSN

1573-742X

Publication Date

July 2012

Volume

34

Issue

1

Start / End Page

126 / 131

Location

Netherlands

Related Subject Headings

  • Tissue Plasminogen Activator
  • Time Factors
  • Tenecteplase
  • Preoperative Care
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Injections, Subcutaneous
  • Humans
  • Fibrinolytic Agents