PMID- 18276619
OWN - NLM
STAT- MEDLINE
DCOM- 20080804
LR  - 20220321
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 29
IP  - 4
DP  - 2008 Feb
TI  - Impact of anticoagulation levels on outcomes in patients undergoing elective 
      percutaneous coronary intervention: insights from the STEEPLE trial.
PG  - 462-71
LID - 10.1093/eurheartj/ehn008 [doi]
AB  - AIMS: To determine the relationship between anticoagulation levels during 
      percutaneous coronary intervention, and ischaemic events and bleeding. METHODS 
      AND RESULTS: A sub-analysis from the STEEPLE trial was conducted. Pre-defined 
      target anticoagulation levels were achieved in 86% of patients receiving 
      enoxaparin, compared with 20% receiving unfractionated heparin (UFH) (P < 0.001). 
      A significant relationship was observed between anti-Xa levels > 0.9 IU/mL and 
      covariate-adjusted rate of non-coronary artery bypass graft-related major and 
      minor bleeding [odds ratio (OR) 1.6, 95% CI 1.0-2.5 for each unit of anti-Xa; P = 
      0.03]; anti-Xa levels and covariate-adjusted incidence of death, myocardial 
      infarction, or revascularization showed no significance (P = 0.47). Major 
      bleeding increased significantly with an activated clotting time (ACT) > 325 s 
      (OR 1.6, 95% CI 1.1-2.2 per 100 s; P = 0.04). A significant relationship with 
      increasing ischaemic events was observed when ACT was < 325 s (OR 0.7, 95% CI 
      0.2-0.8 per 100 s; P = 0.006) indicating a narrow therapeutic window. CONCLUSION: 
      Target anticoagulation levels were achieved more readily in patients receiving 
      enoxaparin. An anti-Xa level of up to 0.9 IU/mL has a good safety and efficacy 
      profile; poor achievement of target ACT with UFH makes assessing the optimal 
      range difficult.
FAU - Montalescot, Gilles
AU  - Montalescot G
AD  - Institut de Cardiologie (AP-HP) and INSERM Unit no. 856, Centre Hospitalier 
      Universitaire Pitie-Salpetriere, Paris, France. gilles.montalescot@psl.aphp.fr
FAU - Cohen, Marc
AU  - Cohen M
FAU - Salette, Genevieve
AU  - Salette G
FAU - Desmet, Walter J
AU  - Desmet WJ
FAU - Macaya, Carlos
AU  - Macaya C
FAU - Aylward, Philip E G
AU  - Aylward PE
FAU - Steg, Ph Gabriel
AU  - Steg PG
FAU - White, Harvey D
AU  - White HD
FAU - Gallo, Richard
AU  - Gallo R
FAU - Steinhubl, Steven R
AU  - Steinhubl SR
CN  - STEEPLE Investigators
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Glycoprotein GPIIb-IIIa Complex)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/*methods
MH  - Anticoagulants/*administration & dosage/blood
MH  - Coronary Thrombosis/blood/prevention & control
MH  - Enoxaparin/administration & dosage/blood
MH  - *Factor Xa Inhibitors
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage/blood
MH  - Heparin/*administration & dosage/blood
MH  - Humans
MH  - Male
MH  - Myocardial Infarction/blood/prevention & control
MH  - Myocardial Ischemia/blood/*therapy
MH  - Platelet Glycoprotein GPIIb-IIIa Complex/administration & dosage
MH  - Whole Blood Coagulation Time/methods
EDAT- 2008/02/16 09:00
MHDA- 2008/08/05 09:00
CRDT- 2008/02/16 09:00
PHST- 2008/02/16 09:00 [pubmed]
PHST- 2008/08/05 09:00 [medline]
PHST- 2008/02/16 09:00 [entrez]
AID - 29/4/462 [pii]
AID - 10.1093/eurheartj/ehn008 [doi]
PST - ppublish
SO  - Eur Heart J. 2008 Feb;29(4):462-71. doi: 10.1093/eurheartj/ehn008.