PMID- 12354703
OWN - NLM
STAT- MEDLINE
DCOM- 20021021
LR  - 20061115
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 106
IP  - 12 Suppl 1
DP  - 2002 Sep 24
TI  - Preoperative use of enoxaparin compared with unfractionated heparin increases the 
      incidence of re-exploration for postoperative bleeding after open-heart surgery 
      in patients who present with an acute coronary syndrome: clinical investigation 
      and reports.
PG  - I19-22
AB  - BACKGROUND: Enoxaparin has become an attractive therapy for use during acute 
      coronary syndrome (ACS) because of its potential superior efficacy over 
      unfractionated heparin (UFH), its longer activity, and its subcutaneous route of 
      administration. However, because a significant number of patients presenting with 
      ACS may be sent directly to open heart surgery while still on anticoagulation, it 
      is important to understand any potential bleeding risks that may be associated 
      with the use of enoxaparin under these circumstances. METHODS: From 1998 to 2001, 
      1159 consecutive patients presenting with an acute coronary syndrome who received 
      either UFH (n=1008) or enoxaparin (n=151) before proceeding to open heart surgery 
      for urgent therapy during the same hospitalization were included in this study. 
      Incidence of perioperative bleeding as evidenced by the units of blood products 
      (packed red blood cells or platelets) transfused or the need for surgical 
      re-exploration for postoperative bleeding was recorded. RESULTS: Average age was 
      65+/-11 and 67+/-11 years for patients receiving UFH and enoxaparin, respectively 
      (P=0.005). Seventy-five percent of those receiving UFH and 64% of those receiving 
      enoxaparin (P<0.005) were males. After discharge, the incidence of 
      rehospitalization for hemorrhage requiring return to surgery for re-exploration 
      was 7.9% in the enoxaparin group and 3.7% in the UFH group (adjusted hazard 
      ratio=2.6, P=0.03). The use of blood products did not differ between groups 
      (UFH=2.7+/-6.5 U and enoxaparin=2.3+/-4.5 U; P=NS). CONCLUSION: The preoperative 
      use of enoxaparin compared with UFH in patients presenting with an ACS who 
      undergo open-heart surgery during the same hospitalization is associated with a 
      significantly increased incidence of re-exploration for postoperative bleeding. 
      Further study is needed to understand the mechanism of this phenomenon and to 
      develop appropriate guidelines to address this potentially important issue.
FAU - Jones, Heath U
AU  - Jones HU
AD  - Cardiovascular Department, LDS Hospital, Salt Lake City, Utah 84143, USA.
FAU - Muhlestein, Joseph B
AU  - Muhlestein JB
FAU - Jones, Kent W
AU  - Jones KW
FAU - Bair, Tami L
AU  - Bair TL
FAU - Lavasani, Farangis
AU  - Lavasani F
FAU - Sohrevardi, Mahtab
AU  - Sohrevardi M
FAU - Horne, Benjamin D
AU  - Horne BD
FAU - Doty, Donald
AU  - Doty D
FAU - Lappe, Donald L
AU  - Lappe DL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Angina, Unstable/diagnosis/surgery
MH  - Blood Component Transfusion
MH  - *Coronary Artery Bypass
MH  - Coronary Disease/diagnosis/*surgery
MH  - Enoxaparin/*adverse effects/therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/*adverse effects/therapeutic use
MH  - Heparin/adverse effects/therapeutic use
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Myocardial Infarction/diagnosis/surgery
MH  - Postoperative Hemorrhage/*chemically induced/epidemiology/surgery
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Syndrome
EDAT- 2002/10/02 04:00
MHDA- 2002/10/22 04:00
CRDT- 2002/10/02 04:00
PHST- 2002/10/02 04:00 [pubmed]
PHST- 2002/10/22 04:00 [medline]
PHST- 2002/10/02 04:00 [entrez]
PST - ppublish
SO  - Circulation. 2002 Sep 24;106(12 Suppl 1):I19-22.