Safety of concomitant therapy with eptifibatide and enoxaparin in patients undergoing percutaneous coronary intervention: results of the Coronary Revascularization Using Integrilin and Single bolus Enoxaparin Study.
OBJECTIVE
This study was designed to assess whether use of enoxaparin during percutaneous coronary intervention (PCI) increased bleeding compared with unfractionated heparin, in addition to background therapy with eptifibatide.


BACKGROUND
Data supporting the benefits of enoxaparin and the glycoprotein IIb/IIIa inhibitor eptifibatide evolved in parallel. Information on combining these two classes of medications is limited.


METHODS
A total of 261 patients undergoing elective or urgent PCI were randomized to either eptifibatide plus enoxaparin or eptifibatide plus unfractionated heparin.


RESULTS
The primary end point of the study, the bleeding index (change in hemoglobin corrected for blood transfusions), was 0.8 in the patients randomized to enoxaparin and 1.1 in patients randomized to unfractionated heparin (p = 0.15). The rate of vascular access site complications was 9.3% in the enoxaparin arm versus 9.8% in the unfractionated heparin arm (p = NS). The rate of bleeding complications was not significantly different between the two arms of the study, including in those patients who received vascular closure devices. The rate of angiographic complications was 6.3% in the enoxaparin group and 6.2% in the unfractionated heparin group (p = NS). Similarly, there were no significant differences in the composite of death, myocardial infarction, or urgent target vessel revascularization at 48 h or 30 days.


CONCLUSIONS
Compared with unfractionated heparin plus eptifibatide, the combination of enoxaparin plus eptifibatide is not associated with an excess of bleeding or vascular complications, including in those receiving closure devices. Despite no monitoring of anticoagulation activity with enoxaparin, there was no apparent increase in angiographic or clinical complications.
Bhatt
Deepak L
DL
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. bhattd@ccf.org
Lee
Benjamin I
BI
Casterella
Peter J
PJ
Pulsipher
Mark
M
Rogers
Matthew
M
Cohen
Marc
M
Corrigan
Victor E
VE
Ryan
Thomas J
TJ
Breall
Jeffrey A
JA
Moses
Jeffrey W
JW
Eaton
Gregory M
GM
Sklar
Mitchel A
MA
Lincoff
A Michael
AM
D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D017023:Coronary Angiography / Q000009:adverse effects; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000009:adverse effects / Q000627:therapeutic use*; D000077542:Eptifibatide; D004864:Equipment and Supplies / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D015607:Stents; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology
D000925:Anticoagulants; D017984:Enoxaparin; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin; D000077542:Eptifibatide