Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: Insights from the STEEPLE trial

Gilles Montalescot, Marc Cohen, Genevieve Salette, Walter J. Desmet, Carlos Macaya, Philip E G Aylward, Ph Gabriel Steg, Harvey D. White, Richard Gallo, Steven R. Steinhubl

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

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.

LanguageEnglish
Pages462-471
Number of pages10
JournalEuropean Heart Journal
Volume29
Issue number4
DOIs
Publication statusPublished - 1 Jan 2008

Keywords

  • Anticoagulation
  • Enoxaparin
  • Percutaneous coronary intervention
  • Unfractionated heparin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Montalescot, Gilles ; Cohen, Marc ; Salette, Genevieve ; Desmet, Walter J. ; Macaya, Carlos ; Aylward, Philip E G ; Steg, Ph Gabriel ; White, Harvey D. ; Gallo, Richard ; Steinhubl, Steven R. / Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention : Insights from the STEEPLE trial. In: European Heart Journal. 2008 ; Vol. 29, No. 4. pp. 462-471.
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abstract = "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.",
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Montalescot, G, Cohen, M, Salette, G, Desmet, WJ, Macaya, C, Aylward, PEG, Steg, PG, White, HD, Gallo, R & Steinhubl, SR 2008, 'Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: Insights from the STEEPLE trial', European Heart Journal, vol. 29, no. 4, pp. 462-471. https://doi.org/10.1093/eurheartj/ehn008

Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention : Insights from the STEEPLE trial. / Montalescot, Gilles; Cohen, Marc; Salette, Genevieve; Desmet, Walter J.; Macaya, Carlos; Aylward, Philip E G; Steg, Ph Gabriel; White, Harvey D.; Gallo, Richard; Steinhubl, Steven R.

In: European Heart Journal, Vol. 29, No. 4, 01.01.2008, p. 462-471.

Research output: Contribution to journalArticle

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T1 - Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention

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AU - Montalescot, Gilles

AU - Cohen, Marc

AU - Salette, Genevieve

AU - Desmet, Walter J.

AU - Macaya, Carlos

AU - Aylward, Philip E G

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AU - White, Harvey D.

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N2 - 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.

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