ASEAN Heart Journal

Intended for healthcare professional

Original Paper

ASEAN Heart Journal

April 2014, 22:4

First online: 03 December 2014

Original Paper

Heparin has No Place as an Anticoagulant in PCI – A Protagonist’s View

Tan Huay Cheem1, 2
Open Access
This content is freely available to anyone, anywhere at any time.
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  • Supplementary Material
  • References
  • About this Article

Abstract

Unfractionated heparin is the standard anticoagulant of choice for patients undergoing percutaneous coronary intervention. However it has signifi cant pharmacologic limitations such as need for frequent laboratory monitoring of anticoagulation status and unpredictable response in acute infl ammatory states. Low molecular weight heparin such as enoxaparin has emerged as a feasible alternative with clinical studies of its use in both elective and emergency PCI indicating that it is just as effective, and has higher safety profi le. With its more predictable anticoagulant response, greater bioavailability, practical clinical benefi ts including early sheath removal; and potential cost saving, enoxaparin has made itself a preferred alternative in modern PCI.

Keywords
Enoxaparin - Activate Clotting Time - Major Bleeding Event - Urgent Revascularization - Enoxaparin Group


Correspondence to Tan Huay Cheem, Director, National University Heart Centre, Singapore; Associate Professor, Yong Loo Lin School of Medicine, National University of Singapore.
Telephone: (+65) 6772 5596. Fax: (+65) 6872 2998. E-mail: [email protected]

Open Access: This article is distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0) which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Supplementary Material

Nil

 

References

1. Dougherty KG, Gaos CM, Bush HS et al. Activated clotting times and activated partial thromboplastin times in patients undergoing coronary angioplasty who receive bolus doses of heparin. Cathet Cardiovasc Diagn 1992;26:260–63. CrossRef

2. Ferguson JJ, Dougherty KG, Gaos CM et al. Relation between procedural activated clotting time and outcome after PTCA. J Am Coll Cardiol 1994;23:1061–65. CrossRef

3. Bowers J, Ferguson JJ. The use of activated clotting times to monitor heparin therapy during and after interventional procedures. Clin Cardiol 1994;17:357–61. PubMed   CrossRef

4. Montalescot G, Collet JP, Tanguay ML et al Anti-Xa activity relates to survival and effi cacy in unselected acute coronary syndrome patients treated with enoxaparin. Circulation 2004; 110: 329–398. CrossRef

5. Gilchrist IC, Berkowitz SD, Thompson TD et al Heparin dosing and outcomes in acute coronary syndromes: The GUSTO-IIb experience. Global Use of Strategies to Open Occluded Coronary Arteries. Am Heart J 2002;144:73–80. PubMed   CrossRef

6. Montalescot G, White HD, Gallo R et al STEEPLE Investigators. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N Engl J Med 2006;355:1006–1017. PubMed   CrossRef

7. Zalc S, Lemos PA, Esteves A et al. Early ambulation and variability in anticoagulation during elective coronary stenting with a single intravenous bolus of low-dose, low molecular weight heparin enoxaparin. J Invasive Cardiol 2006;18:45–48. PubMed

8. Smith SC Jr, Feldman TE, Hirshfeld JW Jr et al. ACC/ AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention. Circulation 2006;113;156–175.

9. White HD, Kleiman NS, Mahaffey KW et al Effi cacy and safety of enoxaparin compared with unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention in the Superior Yield of the New Strategy of Enoxaparin Revascularization and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial. Am Heart J 2006;152:1042–1050. PubMed   CrossRef

10. Borentain M, Montalescot G, Bouzamondo A et al Low-molecular weight heparin vs unfractionated heparin in percutaneous coronary intervention: A combined analysis. Catheter Cardiovasc Interv 2005;65:212–221. PubMed

11. Zeymer U, Gitt A, Junger C et al Effi cacy and safety of enoxaparin in unselected patients with STEMI. Thromb Haemost 2008;99:150–4. PubMed

12. Montalescot G, Ellis SG, de Belder MA et al Enoxaparin in primary and facilitated percutaneous coronary intervention: a formal prospective nonrandomized substudy of the FINESSE trial {Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events}. JACC Cardiovasc Interv 2010;3:203–12. PubMed   CrossRef

13. Montalsecot G, Zeymer U, Silvain J et al Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomized open-label ATOLL trial. Lancet 2011;378:693–703

14. The Task Force on Myocardial Revacsularisation of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010;31:2501–2555

15. Levine GN, Bates ER, Blankenship JC et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011;58:e44–e122. PubMed  CrossRef

About this Article

Title
Heparin has No Place as an Anticoagulant in PCI – A Protagonist’s View


Open Access
Available under Open Access


Journal >> 22:1


Online Date
21 November 2019


DOI
10.7603/s40602-014-0003-3


Online ISSN
2315-4551


Publisher
ASEAN Federation of Cardiology


Additional Links Cardiology


Keywords
Enoxaparin
Activate Clotting Time
Major Bleeding Event
Urgent Revascularization
Enoxaparin Group


Author Affiliations
1. National University Heart Centre, Singapore (NUHCS), Singapore, Singapore
2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore (NUHCS), Singapore


Correspondence to:
Tan Huay Cheem,