Journal article
Changes in coagulation after single i.v. bolus 0.75 mg per kg of the low molecular weight heparin enoxaparin during PCI-a pharmacokinetic study
Cor et vasa (English ed.), Vol.48(6), pp.218-225
06/01/2006
DOI: 10.33678/cor.2006.067
Abstract
Goal and methods:
The clinical efficacy of unstable angina treatment with enoxaparin has been well established, but its indication for optimal anticoagulant treatment in percutaneous coronary intervention (PCI) remains uncertain. The objectives of our observational study were to investigate changes in coagulation tests (APTT, thrombin time [TT], inhibition of F Xa and F IIa and prothrombin fragments F 1 + 2 level) and bleeding complications (according to TIMI criteria) after single i.v. bolus administration of 0.75 mg/kg of enoxaparin to a group of 30 patients during urgent or elective PCI. Additional treatment consisted of only aspirin (100-300 mg) and clopidogrel (loading dose of 300 mg). Arterial blood samples were taken prior to enoxaparin administration (baseline) and 20 minutes, 1 hour, and 6 hours after enoxaparin administration.
Results:
The i.v. bolus of enoxaparin induced an increase in the inhibition of F Xa (1.07 - 0.31 IU/ml, baseline 0.05 - 0.06 IU/ml; p < 0.001) and in the inhibition of F IIa (0.60 - 0.45 IU/ml, baseline 0.28 - 0.14 IU/ml; p < 0.001) at 20 minutes, which continued for 1 hour (anti F Xa 0.91 - 0.34 IU/ml, anti F IIa 0.69 - 0.93 IU/ml; both p < 0,001). The tests were de-creased at baseline levels after 6 hours (anti F Xa 0.10 - 0.12 IU/ml, anti F IIa 0.27 - 0.06 IU/ml). After 20 minutes, we also observed > twofold prolongation of APTT (98.0 - 39.8 s, baseline 32.9 - 4.6 s; p < 0.001) and TT (99.7 - 64.2 s, baseline 15.4 - 2.9 s; p < 0.001), which continued for 1 hour (APTT 87.0 - 39.7 s, TT 75.3 - 61.8 s; both p < 0.001) and returned to baseline after 6 hours (APTT 34.8 - 6.6 s, TT 15.3 - 2.9 s). APTT correlated well with inhibition of F Xa in all periods after the i.v. bolus of enoxaparin, especially at 6 hours (r = 0.58; p < 0.001). Prior the enoxaparin treatment, the levels of F 1 + 2 were increased at baseline (1.21 - 0.36 nmol/l, healthy controls 0.70 - 0.36 nmol/l; p < 0.001). After the i.v. bolus of enoxaparin, the levels of F 1 + 2 were decreased at 20 minutes and at 1 hour (1.07 - 0.43 nmol/l and 1.15 - 0.40 nmol/l, respectively; both p < 0.001) and remained so even after 6 hours (1.04 - 0.33 nmol/l; p < 0.001). No significant bleeding was observed over a period of 6 hours.
Conclusion:
Target anti F Xa levels for PCI (> 0.6 IU/ml) were obtained in 93.3% of patients. No serious bleeding and no rebound phenomenon (increase in F 1 + 2) were observed during a period of 6 hours after a single i.v. dose of 0.75 mg/kg enoxaparin.
Details
- Title: Subtitle
- Changes in coagulation after single i.v. bolus 0.75 mg per kg of the low molecular weight heparin enoxaparin during PCI-a pharmacokinetic study
- Creators
- Jan KvasničkaJan HorákTomáš KvasničkaJana BílkováJiří HumhalStanislav ŠimekTomáš KovárníkIva MalíkováJan BohuslávekMichael Aschermann
- Resource Type
- Journal article
- Publication Details
- Cor et vasa (English ed.), Vol.48(6), pp.218-225
- DOI
- 10.33678/cor.2006.067
- ISSN
- 0010-8650
- eISSN
- 1803-7712
- Language
- English
- Date published
- 06/01/2006
- Academic Unit
- Electrical and Computer Engineering
- Record Identifier
- 9984627232402771
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