PMID- 17621651
OWN - NLM
STAT- MEDLINE
DCOM- 20080212
LR  - 20161124
IS  - 1522-1946 (Print)
IS  - 1522-1946 (Linking)
VI  - 70
IP  - 6
DP  - 2007 Nov 15
TI  - Macroscopic thrombus formation on angioplasty equipment following antithrombin 
      therapy with enoxaparin.
PG  - 847-53
AB  - Increasing evidence suggests that treatment with the low molecular weight heparin 
      enoxaparin during percutaneous coronary intervention (PCI) is safe and effective. 
      We evaluated the incidence and consequences of periprocedural macroscopic 
      thrombus formation on PCI equipment following antithrombin therapy with 
      enoxaparin. Between April 2003 and December 2004, all patients undergoing cardiac 
      catheterization following antithrombin therapy with enoxaparin were evaluated. 
      All patients had blood sampled at the onset of procedure for subsequent 
      measurement of anti-factor-Xa levels. Of the 4,504 patients who underwent PCI 
      during this period, in 122 (3%) the procedure was performed within 8 hr of 
      treatment with subcutaneous enoxaparin and no additional unfractionated heparin 
      (UFH) was used periprocedurally. Of these, macroscopic thrombus was observed on 
      PCI equipment in 6 patients (5%) necessitating withdrawal of all catheters and 
      wires. All patients had therapeutic anti-factor-Xa levels at the time of PCI, and 
      had been treated with double antiplatelet therapy with aspirin and clopidogrel. 
      No periprocedural thrombus was observed in 356 patients who were >12 hr of the 
      last dose of enoxaparin and received UFH at the time of PCI. Following 
      observation of thrombus, additional anticoagulation with UFH resulted in 
      significant epistaxis in one patient. In another patient, the procedure was 
      complicated by distal coronary embolization. Percutaneous coronary intervention 
      following antithrombin therapy with enoxaparin is associated with a 5% incidence 
      of macroscopic thrombus formation on PCI equipment. The necessity for subsequent 
      exchange of all equipment and/or the need for additional anticoagulation may have 
      disastrous consequences for the patient. Our findings suggest that the safety of 
      antithrombin therapy with low molecular weight heparin during PCI requires 
      further evaluation.
FAU - Dana, A
AU  - Dana A
AD  - Department of Cardiology, King's College Hospital, London, United Kingdom.
FAU - Nguyen, C M
AU  - Nguyen CM
FAU - Cloutier, S
AU  - Cloutier S
FAU - Barbeau, G R
AU  - Barbeau GR
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
SB  - IM
CIN - Catheter Cardiovasc Interv. 2007 Nov 15;70(6):854-5. PMID: 18022908
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/*adverse effects/instrumentation
MH  - Coronary Angiography
MH  - Coronary Disease/diagnostic imaging/*therapy
MH  - Enoxaparin/*adverse effects/therapeutic use
MH  - Equipment Failure
MH  - Female
MH  - Fibrinolytic Agents/*adverse effects/therapeutic use
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Factors
MH  - Thrombosis/diagnosis/*etiology
EDAT- 2007/07/11 09:00
MHDA- 2008/02/13 09:00
CRDT- 2007/07/11 09:00
PHST- 2007/07/11 09:00 [pubmed]
PHST- 2008/02/13 09:00 [medline]
PHST- 2007/07/11 09:00 [entrez]
AID - 10.1002/ccd.21253 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2007 Nov 15;70(6):847-53. doi: 10.1002/ccd.21253.