Safety and efficacy of combined use of low molecular weight heparin (enoxaparin, lovenox) and glycoprotein IIb/IIIa receptor antagonist (eptifibatide, integrelin) during nonemergent coronary and peripheral vascular intervention.

Sandeep Khosla, Binu Kunjummen, Mayra Guerrero, Ravi Manda, Mansoor Razminia, Atul Trivedi, Vasundhara Vidyarthi, Monther Elbazour, Aziz Ahmed, David Lubell

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Coronary and peripheral intervention requires intraprocedural anticoagulation to prevent intraluminal thrombosis. Traditionally, unfractionated heparin (UFH) is administered during the procedure to achieve activated clotting time (ACT) of 300 to 400 seconds. When the intravenous IIb/IIIa antagonists are also used, the recommended ACT is 250 to 300 seconds because higher anticoagulation (ACT, 300-400 seconds) is accompanied by an unacceptable bleeding complication rate without added benefits. Because low molecular weight heparin has a more predictable anticoagulant effect and a higher anti-factor Xa/anti-factor IIa ratio, allows better bioavailability, is resistant to inhibition by activated platelets, and does not require routine monitoring using ACT, its use for intraprocedural anticoagulation (instead of UFH) has been an area of increasing interest. The safety and efficacy of coadministration of low molecular weight heparin with IIb/IIIa antagonists have not been adequately evaluated. We report a study of prospective evaluation of the safety and efficacy of combined use of intravenous enoxaparin and intravenous eptifibatide during nonemergent coronary and peripheral vascular intervention in 93 consecutive procedures performed on 56 patients. The procedural success rate was 99% (92/93 procedures), the acute clinical success rate was 98% (54/55 patients), the major bleeding complication rate was 2% (1/56 patients), and the vascular complication rate was 0.0%. In conclusion, the use of intravenous enoxaparin in conjunction with intravenous eptifibatide during nonemergent coronary and peripheral vascular intervention is safe and effective and eliminates the need for routine measurement of ACT during the procedure.

Original languageEnglish (US)
Pages (from-to)488-491
Number of pages4
JournalAmerican journal of therapeutics
Volume9
Issue number6
DOIs
StatePublished - Jan 1 2002
Externally publishedYes

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Enoxaparin
Platelet Glycoprotein GPIIb-IIIa Complex
Low Molecular Weight Heparin
Blood Vessels
Safety
Heparin
Hemorrhage
Factor Xa
Anticoagulants
Biological Availability
Thrombosis
Blood Platelets
eptifibatide
Prospective Studies

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Safety and efficacy of combined use of low molecular weight heparin (enoxaparin, lovenox) and glycoprotein IIb/IIIa receptor antagonist (eptifibatide, integrelin) during nonemergent coronary and peripheral vascular intervention. / Khosla, Sandeep; Kunjummen, Binu; Guerrero, Mayra; Manda, Ravi; Razminia, Mansoor; Trivedi, Atul; Vidyarthi, Vasundhara; Elbazour, Monther; Ahmed, Aziz; Lubell, David.

In: American journal of therapeutics, Vol. 9, No. 6, 01.01.2002, p. 488-491.

Research output: Contribution to journalArticle

Khosla, Sandeep ; Kunjummen, Binu ; Guerrero, Mayra ; Manda, Ravi ; Razminia, Mansoor ; Trivedi, Atul ; Vidyarthi, Vasundhara ; Elbazour, Monther ; Ahmed, Aziz ; Lubell, David. / Safety and efficacy of combined use of low molecular weight heparin (enoxaparin, lovenox) and glycoprotein IIb/IIIa receptor antagonist (eptifibatide, integrelin) during nonemergent coronary and peripheral vascular intervention. In: American journal of therapeutics. 2002 ; Vol. 9, No. 6. pp. 488-491.
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AU - Khosla, Sandeep

AU - Kunjummen, Binu

AU - Guerrero, Mayra

AU - Manda, Ravi

AU - Razminia, Mansoor

AU - Trivedi, Atul

AU - Vidyarthi, Vasundhara

AU - Elbazour, Monther

AU - Ahmed, Aziz

AU - Lubell, David

PY - 2002/1/1

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AB - Coronary and peripheral intervention requires intraprocedural anticoagulation to prevent intraluminal thrombosis. Traditionally, unfractionated heparin (UFH) is administered during the procedure to achieve activated clotting time (ACT) of 300 to 400 seconds. When the intravenous IIb/IIIa antagonists are also used, the recommended ACT is 250 to 300 seconds because higher anticoagulation (ACT, 300-400 seconds) is accompanied by an unacceptable bleeding complication rate without added benefits. Because low molecular weight heparin has a more predictable anticoagulant effect and a higher anti-factor Xa/anti-factor IIa ratio, allows better bioavailability, is resistant to inhibition by activated platelets, and does not require routine monitoring using ACT, its use for intraprocedural anticoagulation (instead of UFH) has been an area of increasing interest. The safety and efficacy of coadministration of low molecular weight heparin with IIb/IIIa antagonists have not been adequately evaluated. We report a study of prospective evaluation of the safety and efficacy of combined use of intravenous enoxaparin and intravenous eptifibatide during nonemergent coronary and peripheral vascular intervention in 93 consecutive procedures performed on 56 patients. The procedural success rate was 99% (92/93 procedures), the acute clinical success rate was 98% (54/55 patients), the major bleeding complication rate was 2% (1/56 patients), and the vascular complication rate was 0.0%. In conclusion, the use of intravenous enoxaparin in conjunction with intravenous eptifibatide during nonemergent coronary and peripheral vascular intervention is safe and effective and eliminates the need for routine measurement of ACT during the procedure.

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