Monitoring of enoxaparin level using citrated clotting time during percutaneous coronary intervention

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.

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.

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).

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.