title: A prospective and randomized comparison of the safety and effects of therapeutic levels of enoxaparin versus unfractionated heparin in chronically anticoagulated patients undergoing elective cardiac catheterization.
abstract: Consecutive patients with atrial fibrillation and/or prosthetic heart valves, receiving chronic anticoagulation with phenprocoumon and scheduled to undergo cardiac catheterization, were randomized to subcutaneous enoxaparin twice daily (n = 32) or intravenous UFH (n = 36). Cardiac catheterization was performed at an international normalized ratio <1.5. Activated partial thromboplastin times and levels of anti-Factor Xa activity were measured daily. The time until effective anticoagulation (primary endpoint) was significantly shorter for enoxaparin than for UFH (1.1 +/- 0.4 days versus 3.7 +/- 2.5 days, p<0.0001). The percentage of days of effective anticoagulation was significantly higher in the enoxaparin group than in the UFH group (93.3 +/- 9.5% versus 53.7 +/- 26.6%, p <0.0001). In conclusion, enoxaparin achieves therapeutic levels of anticoagulation more rapidly and consistently than UFH in chronically anticoagulated patients with prosthetic heart valves and/or atrial fibrillation undergoing cardiac catheterization.
authors.affiliation: Department of Medicine Cardiology, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. omran@uni-bonn.de
authors.forename: Heyder
authors.initials: H
authors.lastname: Omran
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.forename: Giso
authors.initials: G
authors.lastname: von der Recke
authors.forename: Wilhelm Dieter
authors.initials: WD
authors.lastname: Paar
authors.forename: Berndt
authors.initials: B
authors.lastname: Lüderitz
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D000990:Antithrombin III / Q000378:metabolism; D001281:Atrial Fibrillation; D006328:Cardiac Catheterization; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D000990:Antithrombin III; D006493:Heparin