Intravenous enoxaparin anticoagulation in percutaneous left atrial cardiac procedures

Percutaneous transcatheter device closure of left atrial appendage (LAA), patent foramen ovale (PFO) and atrial septal defect (ASD) are usually performed with unfractionated heparin anticoagulation. We report a first experience using intravenous (IV) enoxaparin without anticoagulation monitoring in transcatheter structural heart interventions performed in the left atrium (LA).

This retrospective, non-controlled study included all consecutive and unselected patients who underwent percutaneous LAA, PFO or ASD closure at a tertiary care centre using IV enoxaparin anticoagulation. The primary composite endpoint was the occurrence of in-hospital death, embolic complications (stroke, transient ischaemic attack, and peripheral arterial embolism) and bleedings defined as type 3a or more according to the BARC definitions. We enrolled 198 patients (mean age 60±18 years, 55% male) with an indication for LAA (40.4%), PFO (34.3%) or ASD closure (25.3%). The majority of patients (n=163, 82%) received a single IV enoxaparin dose of 0.5 mg/kg. The composite endpoint occurred in six (3%) patients including four (2%) type 3a bleedings, one (0.5%) transient ischaemic attack and one (0.5%) death from sepsis.

IV enoxaparin without monitoring appears to be a potentially safe and easy-to-use anticoagulation regimen in percutaneous LA cardiac interventions. Further investigations with larger cohorts of patients are warranted.