PMID- 12008169
OWN - NLM
STAT- MEDLINE
DCOM- 20020614
LR  - 20190623
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 89
IP  - 10
DP  - 2002 May 15
TI  - Optimal strategy for administering enoxaparin to patients undergoing coronary 
      angiography without angioplasty for acute coronary syndromes.
PG  - 1167-70
AB  - The optimal strategy for administration of low molecular weight heparin in 
      patients with acute coronary syndrome (ACS) undergoing coronary angiography 
      without percutaneous coronary intervention remains unclear. We studied 
      postangiographic vascular complications in 325 consecutive patients (210 men and 
      115 women, mean age 63 years) with ACS undergoing diagnostic coronary angiography 
      via a femoral approach followed by immediate sheath removal. At the time of 
      angiography, 44 patients were on intravenous unfractionated heparin (UFH), 229 on 
      subcutaneous enoxaparin, and 52 on no heparin. Enoxaparin was withheld on the 
      morning of angiography in 181 of 229 patients: the no A.M. dose group. Vascular 
      complications were audited, including hematoma development at angiographic 
      puncture sites; these complications were considered significant if >25 cm(2). 
      Major vascular complications requiring transfusion or surgical interventions were 
      infrequent in all groups. Patients receiving enoxaparin on the morning of 
      angiography had a twofold increase in significant hematoma rate compared with the 
      no A.M. dose group (31% vs 16%; p = 0.015). The no A.M. dose group had hematoma 
      rates similar to UFH (20%; p = NS) and no anticoagulation (13.5%; p = NS). No 
      significant increase in ischemic episodes occurred as a result of withholding 
      enoxaparin in the no A.M. dose group. We conclude that omission of enoxaparin on 
      the morning of cardiac catheterization results in vascular complications rates 
      comparable to that of UFH without precipitating rebound ischemia. This is a 
      practical, safe strategy for patients with ACS undergoing coronary angiography, 
      allowing early mobilization for most patients who do not proceed to immediate 
      percutaneous coronary intervention.
FAU - Brieger, David
AU  - Brieger D
AD  - Department of Cardiology, Concord Repatriation General Hospital, NSW, Australia. 
      davidb@email.cs.nsw.edu.au
FAU - Solanki, Vijay
AU  - Solanki V
FAU - Gaynor, Maureen
AU  - Gaynor M
FAU - Booth, Virginia
AU  - Booth V
FAU - MacDonald, Robyn
AU  - MacDonald R
FAU - Freedman, S Ben
AU  - Freedman SB
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Anticoagulants/*administration & dosage
MH  - Cardiac Catheterization
MH  - *Coronary Angiography
MH  - Coronary Disease/complications/*diagnosis/*drug therapy
MH  - Dose-Response Relationship, Drug
MH  - Enoxaparin/*administration & dosage
MH  - Female
MH  - Hematoma/chemically induced
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/complications/diagnosis/drug therapy
MH  - Predictive Value of Tests
MH  - Syndrome
MH  - Time Factors
MH  - Treatment Failure
MH  - Vascular Diseases/chemically induced
EDAT- 2002/05/15 10:00
MHDA- 2002/06/18 10:01
CRDT- 2002/05/15 10:00
PHST- 2002/05/15 10:00 [pubmed]
PHST- 2002/06/18 10:01 [medline]
PHST- 2002/05/15 10:00 [entrez]
AID - S0002914902022981 [pii]
AID - 10.1016/s0002-9149(02)02298-1 [doi]
PST - ppublish
SO  - Am J Cardiol. 2002 May 15;89(10):1167-70. doi: 10.1016/s0002-9149(02)02298-1.