Heparin or enoxaparin anticoagulation for primary percutaneous coronary intervention |
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| Authors: | David Brieger MBBS PhD FACC Jean‐Philippe Collet MD PhD Johanne Silvain MD Antoine Landivier MD Olivier Barthélémy MD Farzin Beygui MD PhD Anne Bellemain‐Appaix MD Anne Mercadier MD Remi Choussat MD Nicolas Vignolles BSc Dominique Costagliola MD Gilles Montalescot MD PhD |
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| Affiliation: | 1. Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia;2. Institut de Cardiologie (APHP), INSERM U937 and Univ Paris 6, Pitié‐Salpêtrière Hospital, Paris, France;3. French Blood Establishment, Pitié‐Salpêtrière Hospital, Paris, France;4. Epidemiology and Therapeutic Strategy, INSERM U943 and Univ Pierre et Marie Curie, Pitié‐Salpêtrière Hospital, Paris, France |
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| Abstract: | Objectives : The aim of this study was to compare efficacy and safety outcomes among patients receiving enoxaparin or unfractionated heparin (UFH) while undergoing percutaneous coronary intervention (PCI) for ST‐segment elevation myocardial infarction (STEMI). Background : Primary PCI (pPCI) for ST elevation has traditionally been supported by UFH. The low molecular weight heparin enoxaparin may provide better outcomes when used for pPCI. Methods : Consecutive eligible patients (580) undergoing pPCI enrolled in the prospective electronic Pitié‐Salpêtrière registry of ischemic coronary syndromes (e‐PARIS) registry were grouped according to whether they received UFH or enoxaparin as the sole anticoagulant. Logistic regression modeling, propensity‐weighted adjustment, and sensitivity analyses were used to evaluate efficacy and safety endpoints for enoxaparin vs. UFH. Results : Enoxaparin was administered to 346 patients and UFH to 234 without ACT or anti‐Xa guided dose adjustment. PCI was performed through the radial artery in 90%, with frequent (75%) use of GPIIb/IIIa antagonists. Patients receiving enoxaparin were more likely to be therapeutically anticoagulated during the procedure (68% vs. 50%, P < 0.0001) and were less likely to experience death or recurrent myocardial infarction (MI) in hospital (adjusted OR 0.28 95% CI (0.12–0.68) or by 30 days (adjusted OR 0.35 95% CI 0.16–0.81). All cause mortality was also reduced in hospital (adjusted OR 0.32, 95% CI (0.12–0.85) and to 30 days (adjusted OR 0.40 95% CI 0.17–0.99). Other ischemic endpoints were similarly reduced with enoxaparin. Thrombolysis in myocardial infarction (TIMI) major bleeding events were numerically fewer among patients receiving enoxaparin (1.2% vs. 2.6%, P = 0.2). Conclusions : In patients with STEMI presenting for PCI, enoxaparin was associated with a reduction in all ischemic complications, more frequent therapeutic anticoagulation, and no increase in major bleeding when compared against unfractionated heparin. © 2010 Wiley‐Liss, Inc. |
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| Keywords: | myocardial infarction primary PCI anticoagulants |
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