title: Effectiveness and safety of reduced-dose enoxaparin in non-ST-segment elevation acute coronary syndrome followed by antiplatelet therapy alone for percutaneous coronary intervention.
abstract: Adjunctive pharmacotherapy for stabilizing patients with acute coronary syndrome/non-ST-segment elevation myocardial infarction (ACS/NSTEMI) and for subsequent percutaneous coronary intervention (PCI) includes a combination of anticoagulant and antiplatelet agents. However, all anticoagulants have been shown to paradoxically activate platelets and induce other prothrombotic activities, increase bleeding, and/or cause thrombocytopenia. A single-center experience of 1,400 consecutive patients presenting with ACS/NSTEMI managed using decreased-dose anticoagulation (enoxaparin) and dual-antiplatelet therapy (aspirin and clopidogrel) followed by triple-antiplatelet therapy (aspirin, clopidogrel, and eptifibatide) alone, without additional anticoagulation, during subsequent PCI was retrospectively analyzed. Patients received a median of 3 doses of enoxaparin at a mean dose of 0.51 mg/kg. The final dose was administered 10.8 hours (mean) before PCI. Medical management "failed" in 8 patients (0.6%), and each required emergency PCI. The overall technical success rate was 99.8%. One major adverse clinical event (0.1%) occurred within 24 hours after PCI. Non-Q-wave myocardial infarction occurred in 1.8% of patients, major and minor bleeding complications, in 0.1% and 2.1%, respectively, and thrombocytopenia in 1.3%. Five additional major adverse clinical events (0.4%) occurred within 30 days after PCI, none involving target vessel thrombosis. In conclusion, for patients with ACS/NSTEMI, reduced-dose enoxaparin combined with dual-antiplatelet therapy followed by triple-antiplatelet therapy alone (without additional anticoagulation) during subsequent PCI appears safe and may prove efficacious.
authors.affiliation: University of Florida, Gainesville, FL, USA. scott.denardo@medicine.ufl.edu
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Denardo
authors.forename: Keith E
authors.initials: KE
authors.lastname: Davis
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D017225:Atherectomy, Coronary; D000077144:Clopidogrel; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin