PMID- 19213086
OWN - NLM
STAT- MEDLINE
DCOM- 20090605
LR  - 20101118
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 73
IP  - 3
DP  - 2009 Feb 15
TI  - Impact of anticoagulation regimens on sheath management and bleeding in patients 
      undergoing elective percutaneous coronary intervention in the STEEPLE trial.
PG  - 319-25
LID - 10.1002/ccd.21764 [doi]
AB  - OBJECTIVE: To evaluate the impact of sheath management on bleeding rates. 
      BACKGROUND: The procedural characteristics and anticoagulant regimen determine 
      the frequency of postoperative bleeding complications following percutaneous 
      coronary intervention (PCI). METHODS: This subanalysis of the SafeTy and Efficacy 
      of Enoxaparin in PCI patients, an internationaL randomized Evaluation (STEEPLE) 
      trial evaluated the relative impact of enoxaparin or unfractionated heparin (UFH) 
      on the rate of non-coronary artery bypass graft-related major and minor bleeding, 
      according to sheath management procedures in 3,528 patients undergoing elective 
      PCI with a femoral approach. RESULTS: Sheaths were removed at a median time of 54 
      min with enoxaparin 0.5 mg/kg, compared with 3 hr 14 min with enoxaparin 0.75 
      mg/kg and 2 hr 24 min with UFH. Early sheath removal (within 30 min from the end 
      of PCI) was associated with reduced bleeding in patients receiving 0.5 or 0.75 
      mg/kg enoxaparin compared with UFH (enoxaparin 0.5 mg/kg: 4.9% vs. 10.8%; P < 
      0.001; enoxaparin 0.75 mg/kg: 5.0% vs. 10.8%; P < 0.001). Compared with UFH, 
      major and minor bleeding was halved when enoxaparin (0.5 mg/kg and 0.75 mg/kg) 
      was used in combination with a closure device (4.4% and 5.3% vs. 10.5% with UFH) 
      or smaller (<7 Fr) sheath sizes (4.9% and 6.0% vs. 9.3%). CONCLUSION: This 
      analysis shows that early sheath removal can be performed safely following 
      elective PCI in patients receiving enoxaparin. Enoxaparin use was associated with 
      less major and minor bleeding compared with UFH, when either a closure device or 
      a smaller sheath size was used.
CI  - Copyright 2009 Wiley-Liss, Inc.
FAU - Gallo, Richard
AU  - Gallo R
AD  - Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada. 
      richard.gallo@bellnet.ca
FAU - Steinhubl, Steven R
AU  - Steinhubl SR
FAU - White, Harvey D
AU  - White HD
FAU - Montalescot, Gilles
AU  - Montalescot G
CN  - STEEPLE Investigators
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
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 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Enoxaparin/*administration & dosage/adverse effects
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Injections, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Treatment Outcome
EDAT- 2009/02/13 09:00
MHDA- 2009/06/06 09:00
CRDT- 2009/02/13 09:00
PHST- 2009/02/13 09:00 [entrez]
PHST- 2009/02/13 09:00 [pubmed]
PHST- 2009/06/06 09:00 [medline]
AID - 10.1002/ccd.21764 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2009 Feb 15;73(3):319-25. doi: 10.1002/ccd.21764.