AustralieFrV1, Main, Exploration, bibRecord, 008019

The use of intravenous enoxaparin in elective percutaneous coronary intervention in patients with renal impairment : Results from the SafeTy and Efficacy of Enoxaparin in PCI patients, an internationaL randomized Evaluation (STEEPLE) trial

Identifieur interne : 008019 ( Main/Exploration ); précédent : 008018; suivant : 008020

The use of intravenous enoxaparin in elective percutaneous coronary intervention in patients with renal impairment : Results from the SafeTy and Efficacy of Enoxaparin in PCI patients, an internationaL randomized Evaluation (STEEPLE) trial

Auteurs : Harvey D. White [Nouvelle-Zélande] ; Richard Gallo [Canada] ; Marc Cohen [États-Unis] ; Ph. Gabriel Steg [France] ; Philip E. Aylward [Australie] ; Christoph Bode [Allemagne] ; Steve Steinhubl [États-Unis] ; Gilles Montalescot [France]

Source :

The American heart journal [ 0002-8703 ] ; 2009.

RBID : Pascal:09-0049445

Descripteurs français

Pascal (Inist)
- Insuffisance rénale, Pathologie de l'appareil circulatoire, Utilisation, Voie intraveineuse, Enoxaparine sodique, Electif, Angioplastie, Artère coronaire, Homme, Résultat, Sécurité, Complication, Toxicité, Efficacité, International, Randomisation, Evaluation, Appareil circulatoire, Cardiologie, Traitement instrumental.
Wicri :
- topic : Homme.

English descriptors

KwdEn :
- Angioplasty, Cardiology, Cardiovascular disease, Circulatory system, Complication, Coronary artery, Efficiency, Elective, Enoxaparin sodium, Evaluation, Human, Instrumentation therapy, International, Intravenous administration, Randomization, Renal failure, Result, Safety, Toxicity, Use.

Abstract

Background The STEEPLE trial assessed outcomes of patients undergoing elective percutaneous coronary intervention randomized to receive a bolus of intravenous enoxaparin (0.5 or 0.75 mg/kg, n = 2,298) or activated clotting time-adjusted unfractionated heparin (UFH, n = 1,230), stratified according to planned glycoprotein IIb/IIIa inhibitor use. Methods In this subanalysis, we assessed outcomes in patients with renal impairment (creatinine clearance <60 mL/min, n = 659). Results Major bleeding occurred more often in patients with renal impairment compared with those without (2.7% vs 1.5%, P=.04). Enoxaparin was associated with less major bleeding than UFH with normal renal function (0.9% for enoxaparin 0.5 mg/kg or 1.0% for enoxaparin 0.75 mg/kg vs 2.6%, respectively; both P=.01 vs UFH), with a trend toward less major bleeding with impaired renal function (2.6% or 1.8% vs 3.8%, P =.18 for enoxaparin 0.5 mg/kg and P =.47 for 0.75 mg/kg vs UFH). Minor bleeding rates were similar irrespective of renal function or anticoagulation regimen. The incidence of death, nonfatal myocardial infarction, or urgent target-vessel revascularization was similar between patients with and without renal impairment (5.7% vs 6.5%, P =.45). In patients with renal impairment, event rates were 6.2% or 5.3% with enoxaparin vs 5.6% with UFH (P = nonsignificant). Target anticoagulation levels were achieved 4 to 5 times more often with enoxaparin compared with UFH in patients with normal and impaired renal function (both P<.0001). Conclusions A single bolus of enoxaparin was associated with similar ischemic events and a trend for less major bleeding compared with UFH in patients with renal impairment undergoing percutaneous coronary intervention. Enoxaparin can be administered safely without dose adjustment in these patients.

Affiliations:

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<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Cardiology, Flinders Medical Center</s1>
<s2>Adelaide, South Australia</s2>
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<affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Abteilung Innere Medizin III, Universitätsklinikum Freiburg</s1>
<s2>Freiburg</s2>
<s3>DEU</s3>
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<affiliation wicri:level="1"><inist:fA14 i1="07"><s1>The Adjunct Faculty, Geisinger Clinic, Geisinger Center for Health Research</s1>
<s2>Danville, PA</s2>
<s3>USA</s3>
<sZ>7 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<wicri:noRegion>Danville, PA</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name>
<affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Institut de Cardiologie (AP-HP) and INSERM Unit #856 Centre Hospitalier Universitaire Pitié-Salpêtrière</s1>
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<s3>FRA</s3>
<sZ>8 aut.</sZ>
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<series><title level="j" type="main">The American heart journal</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Angioplasty</term>
<term>Cardiology</term>
<term>Cardiovascular disease</term>
<term>Circulatory system</term>
<term>Complication</term>
<term>Coronary artery</term>
<term>Efficiency</term>
<term>Elective</term>
<term>Enoxaparin sodium</term>
<term>Evaluation</term>
<term>Human</term>
<term>Instrumentation therapy</term>
<term>International</term>
<term>Intravenous administration</term>
<term>Randomization</term>
<term>Renal failure</term>
<term>Result</term>
<term>Safety</term>
<term>Toxicity</term>
<term>Use</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Insuffisance rénale</term>
<term>Pathologie de l'appareil circulatoire</term>
<term>Utilisation</term>
<term>Voie intraveineuse</term>
<term>Enoxaparine sodique</term>
<term>Electif</term>
<term>Angioplastie</term>
<term>Artère coronaire</term>
<term>Homme</term>
<term>Résultat</term>
<term>Sécurité</term>
<term>Complication</term>
<term>Toxicité</term>
<term>Efficacité</term>
<term>International</term>
<term>Randomisation</term>
<term>Evaluation</term>
<term>Appareil circulatoire</term>
<term>Cardiologie</term>
<term>Traitement instrumental</term>
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<front><div type="abstract" xml:lang="en">Background The STEEPLE trial assessed outcomes of patients undergoing elective percutaneous coronary intervention randomized to receive a bolus of intravenous enoxaparin (0.5 or 0.75 mg/kg, n = 2,298) or activated clotting time-adjusted unfractionated heparin (UFH, n = 1,230), stratified according to planned glycoprotein IIb/IIIa inhibitor use. Methods In this subanalysis, we assessed outcomes in patients with renal impairment (creatinine clearance <60 mL/min, n = 659). Results Major bleeding occurred more often in patients with renal impairment compared with those without (2.7% vs 1.5%, P=.04). Enoxaparin was associated with less major bleeding than UFH with normal renal function (0.9% for enoxaparin 0.5 mg/kg or 1.0% for enoxaparin 0.75 mg/kg vs 2.6%, respectively; both P=.01 vs UFH), with a trend toward less major bleeding with impaired renal function (2.6% or 1.8% vs 3.8%, P =.18 for enoxaparin 0.5 mg/kg and P =.47 for 0.75 mg/kg vs UFH). Minor bleeding rates were similar irrespective of renal function or anticoagulation regimen. The incidence of death, nonfatal myocardial infarction, or urgent target-vessel revascularization was similar between patients with and without renal impairment (5.7% vs 6.5%, P =.45). In patients with renal impairment, event rates were 6.2% or 5.3% with enoxaparin vs 5.6% with UFH (P = nonsignificant). Target anticoagulation levels were achieved 4 to 5 times more often with enoxaparin compared with UFH in patients with normal and impaired renal function (both P<.0001). Conclusions A single bolus of enoxaparin was associated with similar ischemic events and a trend for less major bleeding compared with UFH in patients with renal impairment undergoing percutaneous coronary intervention. Enoxaparin can be administered safely without dose adjustment in these patients.</div>
</front>
</TEI>
<affiliations><list><country><li>Allemagne</li>
<li>Australie</li>
<li>Canada</li>
<li>France</li>
<li>Nouvelle-Zélande</li>
<li>États-Unis</li>
</country>
<region><li>Bade-Wurtemberg</li>
<li>District de Fribourg-en-Brisgau</li>
<li>Île-de-France</li>
</region>
<settlement><li>Fribourg-en-Brisgau</li>
<li>Paris</li>
</settlement>
</list>
<tree><country name="Nouvelle-Zélande"><noRegion><name sortKey="White, Harvey D" sort="White, Harvey D" uniqKey="White H" first="Harvey D." last="White">Harvey D. White</name>
</noRegion>
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<country name="Canada"><noRegion><name sortKey="Gallo, Richard" sort="Gallo, Richard" uniqKey="Gallo R" first="Richard" last="Gallo">Richard Gallo</name>
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<country name="États-Unis"><noRegion><name sortKey="Cohen, Marc" sort="Cohen, Marc" uniqKey="Cohen M" first="Marc" last="Cohen">Marc Cohen</name>
</noRegion>
<name sortKey="Steinhubl, Steve" sort="Steinhubl, Steve" uniqKey="Steinhubl S" first="Steve" last="Steinhubl">Steve Steinhubl</name>
</country>
<country name="France"><region name="Île-de-France"><name sortKey="Steg, Ph Gabriel" sort="Steg, Ph Gabriel" uniqKey="Steg P" first="Ph. Gabriel" last="Steg">Ph. Gabriel Steg</name>
</region>
<name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name>
</country>
<country name="Australie"><noRegion><name sortKey="Aylward, Philip E" sort="Aylward, Philip E" uniqKey="Aylward P" first="Philip E." last="Aylward">Philip E. Aylward</name>
</noRegion>
</country>
<country name="Allemagne"><region name="Bade-Wurtemberg"><name sortKey="Bode, Christoph" sort="Bode, Christoph" uniqKey="Bode C" first="Christoph" last="Bode">Christoph Bode</name>
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</tree>
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The use of intravenous enoxaparin in elective percutaneous coronary intervention in patients with renal impairment : Results from the SafeTy and Efficacy of Enoxaparin in PCI patients, an internationaL randomized Evaluation (STEEPLE) trial

The use of intravenous enoxaparin in elective percutaneous coronary intervention in patients with renal impairment : Results from the SafeTy and Efficacy of Enoxaparin in PCI patients, an internationaL randomized Evaluation (STEEPLE) trial

Source :

Descripteurs français

English descriptors

Abstract

Links toward previous steps (curation, corpus...)

Le document en format XML

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Pour mettre un lien sur cette page dans le réseau Wicri