title: Assessment of anticoagulation using activated clotting times in patients receiving intravenous enoxaparin during percutaneous coronary intervention.
abstract: Enoxaparin is being used more frequently in patients undergoing percutaneous coronary intervention (PCI). In this study, we determined the effect of intravenous enoxaparin on activated clotting time (ACT) measurements in the setting of PCI. In 67 consecutive patients, either 1 mg/kg intravenous enoxaparin alone was given for anticoagulation or 0.75 mg/kg given in patients receiving eptifibatide. ACT was measured before and 5 min following enoxaparin administration. After 1 mg/kg enoxaparin (n = 22), mean ACT increased from 122 +/- 22 to 199 +/- 20 sec. After 0.75 mg/kg enoxaparin and eptifibatide (n = 45), mean ACT increased from 125 +/- 22 to 194 +/- 24 sec. The mean increase in ACT was 77 +/- 26 sec in the 1 mg/kg group and 69 +/- 23 sec in the 0.75 mg/kg group (both P values < 0.0001). Moreover, in a subgroup of 26 patients, there was an excellent correlation (r = 0.86) between ACTs and the ENOX test, a new point-of-care test for assessing enoxaparin anticoagulation. None of the patients had transient abrupt closure, thrombus formation, major bleeding, or required urgent revascularization. Intravenous enoxaparin at clinically relevant doses with and without eptifibatide increases ACT levels at 5 min in patients undergoing PCI. These data suggest the ACT may be useful in the assessment of anticoagulation by enoxaparin.
authors.affiliation: Department of Medicine, Division of Cardiology, Scott and White Memorial Hospital and Clinic, Temple, Texas 76508, USA. mlawrence@swmail.sw.org
authors.forename: Mark
authors.initials: M
authors.lastname: Lawrence
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Mixon
authors.forename: Donald
authors.initials: D
authors.lastname: Cross
authors.forename: D Scott
authors.initials: DS
authors.lastname: Gantt
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dehmer
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects*; D003328:Coronary Thrombosis / Q000209:etiology / Q000517:prevention & control*; D017984:Enoxaparin / Q000008:administration & dosage*; D000077542:Eptifibatide; D006801:Humans; D007262:Infusions, Intravenous; D010455:Peptides / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D014914:Whole Blood Coagulation Time / Q000379:methods*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D000077542:Eptifibatide