PMID- 19619692
OWN - NLM
STAT- MEDLINE
DCOM- 20090821
LR  - 20220316
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 158
IP  - 2
DP  - 2009 Aug
TI  - Adding intravenous unfractionated heparin to standard enoxaparin causes excessive 
      anticoagulation not detected by activated clotting time: results of the STACK-on 
      to ENOXaparin (STACKENOX) study.
PG  - 177-84
LID - 10.1016/j.ahj.2009.05.022 [doi]
AB  - BACKGROUND: The STACKENOX study assessed the cumulative anticoagulation effect of 
      administering stack-on intravenous unfractionated heparin (UFH) to subjects 
      already receiving enoxaparin. METHODS: Seventy-two healthy subjects aged 40 to 60 
      years received subcutaneous enoxaparin (1 mg/kg every 12 hours) for 2.5 days 
      (steady state) and were randomized to receive a 70 IU/kg intravenous UFH bolus 4, 
      6, or 10 hours after the final enoxaparin dose. Anticoagulation levels were 
      assessed in subjects receiving enoxaparin alone and after the UFH bolus by 
      monitoring activated clotting time (ACT), anti-Xa and anti-IIa activities, and 
      thrombin generation (endogenous thrombin potential [ETP]). RESULTS: After the 
      final enoxaparin dose, ETP levels decreased by 40%; anti-Xa and anti-IIa 
      activities increased, as expected; and ACT levels did not indicate any 
      anticoagulation effect. Stack-on UFH at 4, 6, or 10 hours after the last 
      enoxaparin dose significantly increased anti-Xa and anti-IIa activities (P < 
      .0001) to well above accepted therapeutic levels and resulted in total inhibition 
      of thrombin generation for > or =2 hours; ACT levels remained within the range 
      commonly observed in subjects receiving UFH. CONCLUSIONS: The administration of 
      stack-on UFH to subjects already receiving recommended enoxaparin dosing may 
      result in over-anticoagulation, and should be avoided. Activated clotting time 
      assessment did not detect the over-anticoagulation resulting from 
      co-administration of enoxaparin and UFH.
FAU - Drouet, Ludovic
AU  - Drouet L
AD  - Department of Angio-Hematology, Hopital Lariboisiere, 2 rue Ambroise Pare, 75475 
      Paris cedex 10, Paris, France. ludovic.drouet@lrb.aphp.fr
FAU - Bal dit Sollier, Claire
AU  - Bal dit Sollier C
FAU - Martin, Jack
AU  - Martin J
LA  - eng
PT  - Clinical Trial, Phase I
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy/physiopathology
MH  - Adult
MH  - Blood Coagulation/*drug effects
MH  - Enoxaparin/*administration & dosage
MH  - Female
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Whole Blood Coagulation Time
EDAT- 2009/07/22 09:00
MHDA- 2009/08/22 09:00
CRDT- 2009/07/22 09:00
PHST- 2009/01/29 00:00 [received]
PHST- 2009/05/18 00:00 [accepted]
PHST- 2009/07/22 09:00 [entrez]
PHST- 2009/07/22 09:00 [pubmed]
PHST- 2009/08/22 09:00 [medline]
AID - S0002-8703(09)00386-X [pii]
AID - 10.1016/j.ahj.2009.05.022 [doi]
PST - ppublish
SO  - Am Heart J. 2009 Aug;158(2):177-84. doi: 10.1016/j.ahj.2009.05.022.