BACKGROUND: Subcutaneous enoxaparin is increasingly employed as the antithrombin of choice in non-ST elevation myocardial infarction and in conjunction with various fibrinolytic regimens in acute ST elevation myocardial infarction (STEMI). Few data exist describing the use of subcutaneous or intravenous enoxaparin as an anticoagulant in the highly thrombotic setting of primary percutaneous coronary intervention (PCI) for STEMI. METHODS: The Which Early ST Elevation Therapy (WEST) study compared fibrinolysis (with and without early cardiac catheterization) with primary PCI in a setting that expedited both strategies on first medical contact. Patients assigned primary PCI are administered acetylsalicylic acid 325 mg, clopidogrel 300 mg and subcutaneous enoxaparin 1 mg/kg before transport to a PCI centre. Of 36 initial patients treated with primary PCI, three patients had procedures that were complicated by extensive thrombosis within coronary catheters and on PCI equipment. RESULTS: Index cases were men aged 43 to 68 years who presented with confirmed STEMI and angiographically proven acute total or subtotal occlusion of a major epicardial coronary segment. During PCI, performed 76 min to 102 min following enoxaparin administration, a clot developed within the guide catheter or on the coronary guidewires and balloon catheter shafts, thus necessitating the replacement of all PCI equipment. In one case, there was evidence of continued intracoronary clot propagation and embolization. CONCLUSION: A single, conventional, weight-adjusted dose of subcutaneous enoxaparin before expedited primary PCI for STEMI may not provide a reliable antithrombotic effect. Supplementary intravenous enoxaparin is now strongly recommended within the WEST study, and a substudy evaluating pre- and postprocedural antifactor Xa activity has been initiated.
BACKGROUND: Subcutaneous enoxaparin is increasingly employed as the antithrombin of choice in non-ST elevation myocardial infarction and in conjunction with various fibrinolytic regimens in acute ST elevation myocardial infarction (STEMI). Few data exist describing the use of subcutaneous or intravenous enoxaparin as an anticoagulant in the highly thrombotic setting of primary percutaneous coronary intervention (PCI) for STEMI. METHODS: The Which Early ST Elevation Therapy (WEST) study compared fibrinolysis (with and without early cardiac catheterization) with primary PCI in a setting that expedited both strategies on first medical contact. Patients assigned primary PCI are administered acetylsalicylic acid 325 mg, clopidogrel 300 mg and subcutaneous enoxaparin 1 mg/kg before transport to a PCI centre. Of 36 initial patients treated with primary PCI, three patients had procedures that were complicated by extensive thrombosis within coronary catheters and on PCI equipment. RESULTS: Index cases were men aged 43 to 68 years who presented with confirmed STEMI and angiographically proven acute total or subtotal occlusion of a major epicardial coronary segment. During PCI, performed 76 min to 102 min following enoxaparin administration, a clot developed within the guide catheter or on the coronary guidewires and balloon catheter shafts, thus necessitating the replacement of all PCI equipment. In one case, there was evidence of continued intracoronary clot propagation and embolization. CONCLUSION: A single, conventional, weight-adjusted dose of subcutaneous enoxaparin before expedited primary PCI for STEMI may not provide a reliable antithrombotic effect. Supplementary intravenous enoxaparin is now strongly recommended within the WEST study, and a substudy evaluating pre- and postprocedural antifactor Xa activity has been initiated.
Authors: Rémi Choussat; Gilles Montalescot; Jean Philippe Collet; Eric Vicaut; Annick Ankri; Vanessa Gallois; Gérard Drobinski; Ivan Sotirov; Daniel Thomas Journal: J Am Coll Cardiol Date: 2002-12-04 Impact factor: 24.094
Authors: Mina Madan; Shyam Radhakrishnan; Marciano Reis; Fran L Paradiso-Hardy; Maggie Godin-Edgecombe; Catherine Sparling; Anne Marie Phillips; Shamila Shanmugasegaram; Stephen Fort; Salim Z Naqvi; Eric A Cohen Journal: Am J Cardiol Date: 2005-06-01 Impact factor: 2.778
Authors: Elliott M Antman; Hans W Louwerenburg; Hubert F Baars; Jan C L Wesdorp; Bas Hamer; Jean-Pierre Bassand; Frederique Bigonzi; Ghislaine Pisapia; C Michael Gibson; Hein Heidbuchel; Eugene Braunwald; Frans Van de Werf Journal: Circulation Date: 2002-04-09 Impact factor: 29.690
Authors: M M Rabah; J Premmereur; M Graham; J Fareed; D A Hoppensteadt; L L Grines; C L Grines Journal: Am J Cardiol Date: 1999-12-15 Impact factor: 2.778
Authors: L Wallentin; P Goldstein; P W Armstrong; C B Granger; A A J Adgey; H R Arntz; K Bogaerts; T Danays; B Lindahl; M Mäkijärvi; F Verheugt; F Van de Werf Journal: Circulation Date: 2003-07-07 Impact factor: 29.690
Authors: Robert C Welsh; Cynthia M Westerhout; Christopher E Buller; Blair O'Neill; Phillip Gordon; Paul W Armstrong Journal: J Thromb Thrombolysis Date: 2012-07 Impact factor: 2.300
Authors: Mark Y Chan; Jeffrey I Weitz; Yahye Merhi; Robert A Harrington; Richard C Becker Journal: J Thromb Thrombolysis Date: 2009-10 Impact factor: 2.300