Anticoagulant profile of supplementary-dose enoxaparin in patients undergoing prolonged percutaneous coronary intervention

Abstract

Abstract Background Enoxaparin 0.75 mg/kg, with either a staged-dose regimen (0.5+0.25 mg/dl) or a single-dose regimen (0.75 mg/dl) achieves target anticoagulation for 90 min in patients undergoing percutaneous coronary intervention (PCI). In patients with prolonged procedures (>90 min), a supplementary-dose enoxaparin (0.375 mg/kg) needs to be given at 90 min to maintain target anticoagulation for additional 90 min. However, the actual anticoagulant profile of this supplementary-dose regimen remains unknown because it is recommended only based on pharmacokinetic simulations. Purpose This study directly assessed the anticoagulant profile of supplementary-dose enoxaparin (0.375 mg/kg) in troponin-negative patients undergoing prolonged elective trans-radial PCI who received a total dose of enoxaparin 0.75 mg/kg during the first 90 min of their procedures. Methods In 33 patients with prolonged procedures, 15 patients received enoxaparin 0.5 mg/kg at the beginning of coronary angiography and additional enoxaparin 0.25 mg/kg before PCI (Staged-dose regimen); while, 18 patients received enoxaparin 0.75 mg/kg at the beginning of coronary angiography without additional dose before PCI (Single-dose regimen). A supplementary-dose enoxaparin (0.375 mg/kg) was administered at 90 min after the first dose was given, and every 90 min thereafter until the end of PCI. Anti-Xa levels were assessed at 0 min (immediately before), 10 min and 90 min after each supplementary dose was given (S_0min, S_10min, and S_90min, respectively). Target anticoagulation was defined as anti-Xa level of 0.5–1.8 IU/ml. Results In patients who received only one supplementary dose (n=28), the anti-Xa levels were S1_0min: 0.87±0.19 IU/ml, S1_10min: 1.44±0.21 IU/ml, and S1_90min: 1.10±0.21 IU/ml. In patients who received two supplementary doses (n=5), the anti-Xa levels were S1_0min: 0.86±0.07 IU/ml, S1_10min: 1.27±0.27 IU/ml, and S1_90min: 1.03±0.23 IU/ml, as well as S2_0min: 1.03±0.23 IU/ml, S2_10min: 1.56±0.28 IU/ml, and S2_90min: 1.28±0.18 IU/ml, respectively. No patient received more than two doses of supplementary enoxaparin. All anti-Xa levels were within the range of target anticoagulation except for two patients receiving one supplementary dose (S1_10min: 1.96 IU/ml and 1.81 IU/ml, respectively) and another one receiving two supplementary doses (S2_10min: 1.87 IU/ml). Conclusions In patients undergoing prolonged PCI who received a total dose of enoxaparin 0.75 mg/kg during the first 90 min of their procedures, a supplementary-dose enoxaparin (0.375 mg/kg), which was administered at 90 min and every 90 min thereafter, maintained target anticoagulation for additional 90 min each time it was given. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Peking Union Medical College Hospital (PUMCH) Science Fund for Junior Faculty