PMID- 26720847
OWN - NLM
STAT- MEDLINE
DCOM- 20170309
LR  - 20170817
IS  - 1473-5733 (Electronic)
IS  - 0957-5235 (Linking)
VI  - 27
IP  - 7
DP  - 2016 Oct
TI  - Enoxaparin chains stored during chronic treatment are mobilized by a bolus of 
      unfractionated heparin: insights from the STACKENOX study.
PG  - 779-785
AB  - The initial STACKENOX (STACK-on to ENOXaparin) study investigated the effect of 
      stacking unfractionated heparin (UFH) onto a chronic treatment with enoxaparin, a 
      common practice in interventional cardiology when a patient treated with 
      enoxaparin receives an additional bolus of UFH at the time of percutaneous 
      coronary intervention. The study brought to light some unexpected consequences on 
      coagulation tests and hemorrhagic risk. This substudy was performed to provide a 
      pharmacological explanation for these observations. Seventy-two healthy 
      individuals previously treated with enoxaparin for 2.5 days received a stack-on 
      of 70 IU/kg intravenous UFH dose 4, 6, or 10 h after the last enoxaparin dose. 
      Anticoagulation activity was monitored by activated partial thromboplastin time, 
      anti-Xa and anti-IIa activities and a thrombin generation test. In parallel, 
      plasma samples of the individuals receiving the chronic enoxaparin treatment 
      obtained at 4, 6, or 10 h after the last enoxaparin dose were spiked in vitro 
      with a dose of UFH reproducing the concentration achieved in vivo after the bolus 
      of UFH alone. In-vivo stack-on of UFH induced an over-anticoagulation identified 
      by changes in anti-Xa and, less markedly, in anti-IIa and activated partial 
      thromboplastin time levels, whereas in-vitro UFH spiking, only produced an 
      additive effect. We hypothesize that the potentiation of UFH on anti-Xa activity 
      observed in vivo may caused by the UFH bolus mobilizing enoxaparin chains stored 
      in the endothelial glycocalyx during chronic pretreatment. This 
      over-anticoagulation and its potential hemorrhagic risk after stack-on of UFH 
      have obvious clinical implications.
FAU - Bal Dit Sollier, Claire
AU  - Bal Dit Sollier C
AD  - aThrombosis and Atherosclerosis Research Unit, Vessels and Blood Institut, 
      Lariboisiere Hospital bAnticoagulation Clinic (CREATIF), Hopital Lariboisiere 
      cParis VII University EA 7334 REMES, Paris, France.
FAU - Berge, Natacha
AU  - Berge N
FAU - Drouet, Ludovic
AU  - Drouet L
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - England
TA  - Blood Coagul Fibrinolysis
JT  - Blood coagulation & fibrinolysis : an international journal in haemostasis and 
      thrombosis
JID - 9102551
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/administration & dosage/*therapeutic use
MH  - Enoxaparin/administration & dosage/*therapeutic use
MH  - Female
MH  - Heparin/pharmacology/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
EDAT- 2016/10/18 06:00
MHDA- 2017/03/10 06:00
CRDT- 2016/01/01 06:00
PHST- 2016/10/18 06:00 [pubmed]
PHST- 2017/03/10 06:00 [medline]
PHST- 2016/01/01 06:00 [entrez]
AID - 10.1097/MBC.0000000000000489 [doi]
PST - ppublish
SO  - Blood Coagul Fibrinolysis. 2016 Oct;27(7):779-785. doi: 
      10.1097/MBC.0000000000000489.