A novel point-of-care enoxaparin monitor for use during percutaneous coronary intervention: Results of the evaluating enoxaparin clotting times (ELECT) study

David J. Moliterno, James B. Hermiller, Dean J. Kereiakes, Eric Yow, Robert J. Applegate, Gregory A. Braden, Eric J. Dippel, Mark I. Furman, Cindy L. Grines, Neal S. Kleiman, Glenn N. Levine, Tift Mann, Ravi N. Nair, Ronald A. Stine, Steven J. Yacubov, James E. Tcheng

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

OBJECTIVES: The aim of this study was to discern a target range of anticoagulation for enoxaparin during percutaneous coronary intervention (PCI) as measured by the Rapidpoint ENOX (Pharmanetics Inc., Morrisville, North Carolina), a new point-of-care test. BACKGROUND: In the U.S., enoxaparin has been used in only a small proportion of PCI procedures, partly because a rapid enoxaparin-specific assay was unavailable. METHODS: We analyzed data from 445 enrolled patients receiving subcutaneous or intravenous enoxaparin in a prospective, multicenter study. Serial anticoagulation measurements and clinical outcomes were recorded. RESULTS: The in-hospital composite occurrence of death, myocardial infarction, and urgent target vessel revascularization was 5.4%, and Thrombolysis In Myocardial Infarction (TIMI) major bleeding, minor bleeding, and any reported bleeding occurred in 0.2%, 1.3%, and 7.9% of patients, respectively. No significant association between procedural ENOX times and ischemic events was observed (p = 0.222), although the event rate was 4.0% among those with ENOX times between 250 to 450 s versus 7.2% for those outside this range (p = 0.134). Increasing ENOX time at sheath removal was correlated with any bleeding (p = 0.010) with a 1% increase for every ∼30-s rise. CONCLUSIONS: Ischemic events were infrequent, and the rate appeared lowest in the mid-range of ENOX times. Bleeding events increased with increasing ENOX times. These observations, combined with a suggested procedural anti-Xa level of 0.8 to 1.8 IU/ml, translate into a recommended ENOX time range of 250 to 450 s for PCI and <200 to 250 s for sheath removal.

Original languageEnglish (US)
Pages (from-to)1132-1139
Number of pages8
JournalJournal of the American College of Cardiology
Volume42
Issue number6
DOIs
StatePublished - Sep 17 2003

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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