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Published on: March 15, 2022
Heparin or enoxaparin anticoagulation for primary percutaneous coronary intervention
David Brieger1, Jean-Philippe Collet, Johanne Silvain
1Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
Insights
Enoxaparin use during percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) reduced ischemic complications and mortality. This low molecular weight heparin showed improved therapeutic anticoagulation without increasing major bleeding compared to unfractionated heparin (UFH).
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Unfractionated heparin (UFH) is the traditional anticoagulant for primary percutaneous coronary intervention (pPCI).
- Enoxaparin, a low molecular weight heparin, may offer improved outcomes in pPCI settings.
Purpose of the Study:
- To compare the efficacy and safety of enoxaparin versus UFH in patients undergoing PCI for ST-elevation myocardial infarction (STEMI).
- To evaluate ischemic and bleeding complications associated with each anticoagulant in this patient population.
Main Methods:
- A prospective analysis of 580 patients undergoing pPCI within the e-PARIS registry.
- Patients received either enoxaparin or UFH as sole anticoagulant, with outcomes assessed using logistic regression and propensity-weighted adjustments.
Main Results:
- Enoxaparin use was associated with more frequent therapeutic anticoagulation (68% vs. 50%).
- Patients receiving enoxaparin had significantly lower rates of in-hospital death or recurrent MI (adjusted OR 0.28) and at 30 days (adjusted OR 0.35).
- All-cause mortality was also reduced with enoxaparin, and major bleeding events were numerically fewer.
Conclusions:
- Enoxaparin use in STEMI patients undergoing PCI is linked to reduced ischemic complications and mortality.
- Enoxaparin demonstrated more effective anticoagulation and a favorable safety profile, with no increase in major bleeding compared to UFH.
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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