Details

Autor(en) / Beteiligte

• Montalescot, Gilles
• Cohen, Marc
• Salette, Genevieve
• Desmet, Walter J.
• Macaya, Carlos
• Aylward, Philip E.G.
• Steg, Ph. Gabriel
• White, Harvey D.
• Gallo, Richard
• Steinhubl, Steven R.

Titel

Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial

Ist Teil von

• European heart journal, 2008-02, Vol.29 (4), p.462-471

Ort / Verlag

Oxford: Oxford University Press

Erscheinungsjahr

2008

Link zum Volltext

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Aims To determine the relationship between anticoagulation levels during percutaneous coronary intervention, and ischaemic events and bleeding. Methods and results A sub-analysis from the STEEPLE trial was conducted. Pre-defined target anticoagulation levels were achieved in 86% of patients receiving enoxaparin, compared with 20% receiving unfractionated heparin (UFH) (P < 0.001). A significant relationship was observed between anti-Xa levels > 0.9 IU/mL and covariate-adjusted rate of non-coronary artery bypass graft-related major and minor bleeding [odds ratio (OR) 1.6, 95% CI 1.0–2.5 for each unit of anti-Xa; P = 0.03]; anti-Xa levels and covariate-adjusted incidence of death, myocardial infarction, or revascularization showed no significance (P = 0.47). Major bleeding increased significantly with an activated clotting time (ACT) > 325 s (OR 1.6, 95% CI 1.1–2.2 per 100 s; P = 0.04). A significant relationship with increasing ischaemic events was observed when ACT was < 325 s (OR 0.7, 95% CI 0.2–0.8 per 100 s; P = 0.006) indicating a narrow therapeutic window. Conclusion Target anticoagulation levels were achieved more readily in patients receiving enoxaparin. An anti-Xa level of up to 0.9 IU/mL has a good safety and efficacy profile; poor achievement of target ACT with UFH makes assessing the optimal range difficult.