PMID- 16685318
OWN - NLM
STAT- MEDLINE
DCOM- 20060629
LR  - 20211020
IS  - 0828-282X (Print)
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 22
IP  - 6
DP  - 2006 May 1
TI  - Catheter thrombosis during primary percutaneous coronary intervention for acute 
      ST elevation myocardial infarction despite subcutaneous low-molecular-weight 
      heparin, acetylsalicylic acid, clopidogrel and abciximab pretreatment.
PG  - 511-5
AB  - BACKGROUND: Subcutaneous enoxaparin is increasingly employed as the antithrombin 
      of choice in non-ST elevation myocardial infarction and in conjunction with 
      various fibrinolytic regimens in acute ST elevation myocardial infarction 
      (STEMI). Few data exist describing the use of subcutaneous or intravenous 
      enoxaparin as an anticoagulant in the highly thrombotic setting of primary 
      percutaneous coronary intervention (PCI) for STEMI. METHODS: The Which Early ST 
      Elevation Therapy (WEST) study compared fibrinolysis (with and without early 
      cardiac catheterization) with primary PCI in a setting that expedited both 
      strategies on first medical contact. Patients assigned primary PCI are 
      administered acetylsalicylic acid 325 mg, clopidogrel 300 mg and subcutaneous 
      enoxaparin 1 mg/kg before transport to a PCI centre. Of 36 initial patients 
      treated with primary PCI, three patients had procedures that were complicated by 
      extensive thrombosis within coronary catheters and on PCI equipment. RESULTS: 
      Index cases were men aged 43 to 68 years who presented with confirmed STEMI and 
      angiographically proven acute total or subtotal occlusion of a major epicardial 
      coronary segment. During PCI, performed 76 min to 102 min following enoxaparin 
      administration, a clot developed within the guide catheter or on the coronary 
      guidewires and balloon catheter shafts, thus necessitating the replacement of all 
      PCI equipment. In one case, there was evidence of continued intracoronary clot 
      propagation and embolization. CONCLUSION: A single, conventional, weight-adjusted 
      dose of subcutaneous enoxaparin before expedited primary PCI for STEMI may not 
      provide a reliable antithrombotic effect. Supplementary intravenous enoxaparin is 
      now strongly recommended within the WEST study, and a substudy evaluating pre- 
      and postprocedural antifactor Xa activity has been initiated.
FAU - Buller, Christopher E
AU  - Buller CE
AD  - University of British Columbia, Vancouver. cbuller@providencehealth.bc.ca
FAU - Pate, Gordon E
AU  - Pate GE
FAU - Armstrong, Paul W
AU  - Armstrong PW
FAU - O'Neill, Blair J
AU  - O'Neill BJ
FAU - Webb, John G
AU  - Webb JG
FAU - Gallo, Richard
AU  - Gallo R
FAU - Welsh, Robert C
AU  - Welsh RC
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Immunoglobulin Fab Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
RN  - X85G7936GV (Abciximab)
SB  - IM
MH  - Abciximab
MH  - Adult
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/*adverse effects
MH  - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
MH  - Antibodies, Monoclonal/therapeutic use
MH  - Anticoagulants/administration & dosage/therapeutic use
MH  - Aspirin/therapeutic use
MH  - Cardiac Catheterization
MH  - Clopidogrel
MH  - Enoxaparin/administration & dosage/therapeutic use
MH  - Female
MH  - Humans
MH  - Immunoglobulin Fab Fragments/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*therapy
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
MH  - *Thrombolytic Therapy
MH  - Thrombosis/*etiology
MH  - Ticlopidine/analogs & derivatives/therapeutic use
PMC - PMC2560555
EDAT- 2006/05/11 09:00
MHDA- 2006/06/30 09:00
PMCR- 2007/05/01
CRDT- 2006/05/11 09:00
PHST- 2006/05/11 09:00 [pubmed]
PHST- 2006/06/30 09:00 [medline]
PHST- 2006/05/11 09:00 [entrez]
PHST- 2007/05/01 00:00 [pmc-release]
AID - S0828-282X(06)70271-9 [pii]
AID - cjc220511 [pii]
AID - 10.1016/s0828-282x(06)70271-9 [doi]
PST - ppublish
SO  - Can J Cardiol. 2006 May 1;22(6):511-5. doi: 10.1016/s0828-282x(06)70271-9.