Use of enoxaparin in emergency room for improving outcomes of primary percutaneous coronary interventions for acute myocardial infarction.
OBJECTIVE
Outcomes of primary angioplasty can be improved by achieving better pre/post PCI TIMI flows. Earlier administration of antithrombotic and antiplatelet agents may help in achieving better TIMI flows. We evaluated the role of intravenous bolus of enoxaparin administered immediately after the diagnosis of STEMI in the emergency room.


METHODS
We compared the data of 100 consecutive patients in the emergency room, administered intravenous enoxaparin immediately after the diagnosis of STEMI (within 12 hours from the onset of pain). The patients had undergone primary PCI with 100 patients receiving unfractionated heparin administered during primary PCI. All patients received 325 mg Aspirin, 300 mg Clopidogrel on admission and platelet IIb/IIIa antagonist during and after PCI. Enoxaparin group received 0.6 ml IV enoxaparin (0.8 ml if weight > 80 kg). TIMI flows on pre/post PCI angiograms were studied. Clinical end points included death and MACE rates at 30 days.


RESULTS
Both the groups were demographically similar. Pre PCI TIMI 2/3 flow increased from 18%-24% (p = 0.385). TIMI 3 flow increased from 8%-17% (p = 0.087). Post PCI TIMI 3 flow increased from 91%-96% (p = 0.251). There was absolute improvement of 9% in pre PCI TIMI 3 flow and 5% in post PCI TIMI 3 flow. There was no significant difference in the mortality and MACE rates at 30 days.


CONCLUSIONS
Enoxaparin administered early in the emergency room after the diagnosis of STEMI improved pre and post PCI TIMI 3 flows with an absolute improvement of 9% in pre PCI TIMI 3 flow. Death and MACE rates showed trends towards improvement although they were not statistically significant.
Abhyankar
Atul D
AD
Heartfirst Cardiac & Vascular Centre, Surat, India. atulda@hotmail.com
Pothiawala
Sohil E
SE
Kazi
Girish J
GJ
Jha
Mahendu J
MJ
Petrolwala
Mukur
M
D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D017984:Enoxaparin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin