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Background: Enoxaparin has gained wide acceptance in patients with acut e coron ary syndromes. However, there is uncertainty regarding management of patients wh o require coronary intervention while on enoxaparin. Some physicians withhold th e morning dose of enoxaparin prior to coronary intervention while others switch patients to unfractionated heparin. Both methods do not provide optimal anticoag ulation in the hours preceding intervention. There are no published controlled data to assess the safety of coronary intervention using enoxaparin alone in patients with acute coronary syndromes. Methods: We p rospectively compared enoxaparin to unfractionated heparin during coronary angio graphy and intervention. Sixty four patients admitted to the coronary care unit( CCU)were given enoxaparin twice daily, including on the morning of procedure. Co ronary angiography and intervention were performed without additional unfraction ated heparin. The control group comprised of 52 patients admitted to Internal Me dicine for an acute coronary syndrome. These were also given enoxaparin but the morning dose was withheld and unfractionated heparin was used during procedure. Results: Patients in both groups had similar baseline characteristics. No signif icant differences were observed between the two groups in procedural success rat e, complications or bleeding. One year follow up showed similar rates of hospita lization and mortality. Conclusion: Enoxaparin seems to offer safe and effective procedural anticoagulation in patients undergoing percutaneous intervention for acute coronary syndromes. Patients given enoxaparin can probably have coronary intervention without interruption of enoxaparin treatment and without additional procedural anticoagulation. These findings require confirmation in larger, rand omized trials.
Background: Enoxaparin has gained wide acceptance in patients with acut e coron ary syndromes. However, there is uncertainty regarding management of patients wh o require coronary intervention while on enoxaparin. Some physicians withhold th e morning dose of enoxaparin prior to coronary intervention while others switch Patients to unfractionated heparin. Both methods do not provide optimal anticoag ulation in the hours preceding intervention. There are no published controlled data to assess the safety of coronary intervention using enoxaparin alone in patients with acute coronary syndromes. Methods: We p rospectively compared enoxaparin to unfractionated heparin during coronary angio graphy and intervention. sixty four patients admitted to the coronary care unit (CCU) were given enoxaparin twice daily, including on the morning of procedure. comprised of 52 patients admitt ed to Internal Me dicine for an acute coronary syndrome. These were also given enoxaparin but the morning dose was withheld and unfractionated heparin was used during procedure. Results: Patients in both groups were similar baseline characteristics. No signif icant differences were observed between the two groups in procedural success rat e, complications or bleeding. One year follow up showed similar similar hospita lization and mortality. Conclusion: Enoxaparin seems to offer safe and effective procedural anticoagulation in patients undergoing percutaneous intervention for acute coronary syndromes. Patients given enoxaparin can probably have coronary intervention without interruption of enoxaparin treatment and without additional procedural anticoagulation. These Recommendations require confirmation in larger, rand omized trials.