Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial
Identifieur interne : 008686 ( Main/Exploration ); précédent : 008685; suivant : 008687Impact of anticoagulation levels on outcomes in patients undergoing elective percutaneous coronary intervention: insights from the STEEPLE trial
Auteurs : Gilles Montalescot [France] ; Marc Cohen [États-Unis] ; Genevieve Salette [France] ; Walter J. Desmet [Belgique] ; Carlos Macaya [Espagne] ; Philip E. G. Aylward [Australie] ; Ph. Gabriel Steg [France] ; Harvey D. White [Nouvelle-Zélande] ; Richard Gallo [Canada] ; Steven R. Steinhubl [États-Unis]Source :
- European Heart Journal [ 0195-668X ] ; 2008-02.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
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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.
Url:
DOI: 10.1093/eurheartj/ehn008
Affiliations:
- Australie, Belgique, Canada, Espagne, France, Nouvelle-Zélande, États-Unis
- Communauté de Madrid, Kentucky, New Jersey, Québec, Île-de-France
- Madrid, Montréal, Paris
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Le document en format XML
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White</name><affiliation wicri:level="1"><country xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>Green Lane Cardiovascular Service, Auckland City Hospital, Auckland</wicri:regionArea><wicri:noRegion>Auckland</wicri:noRegion></affiliation></author><author><name sortKey="Gallo, Richard" sort="Gallo, Richard" uniqKey="Gallo R" first="Richard" last="Gallo">Richard Gallo</name><affiliation wicri:level="3"><country xml:lang="fr">Canada</country><wicri:regionArea>Montreal Heart Institute, Université de Montréal, Montréal</wicri:regionArea><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Steinhubl, Steven R" sort="Steinhubl, Steven R" uniqKey="Steinhubl S" first="Steven R." last="Steinhubl">Steven R. Steinhubl</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Cardiology, University of Kentucky, Lexington, KY</wicri:regionArea><placeName><region type="state">Kentucky</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2008-02">2008-02</date><biblScope unit="volume">29</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="462">462</biblScope><biblScope unit="page" to="471">471</biblScope></imprint><idno type="ISSN">0195-668X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Angioplasty</term><term>Cardiology</term><term>Circulatory system</term><term>Coronary artery</term><term>Elective</term><term>Enoxaparin sodium</term><term>Evolution</term><term>Heparin</term><term>Human</term><term>Instrumentation therapy</term><term>Level</term><term>Phlebology</term><term>Prognosis</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Angioplastie</term><term>Appareil circulatoire</term><term>Artère coronaire</term><term>Cardiologie</term><term>Electif</term><term>Enoxaparine sodique</term><term>Evolution</term><term>Homme</term><term>Héparine</term><term>Niveau</term><term>Phlébologie</term><term>Pronostic</term><term>Traitement instrumental</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="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.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Belgique</li><li>Canada</li><li>Espagne</li><li>France</li><li>Nouvelle-Zélande</li><li>États-Unis</li></country><region><li>Communauté de Madrid</li><li>Kentucky</li><li>New Jersey</li><li>Québec</li><li>Île-de-France</li></region><settlement><li>Madrid</li><li>Montréal</li><li>Paris</li></settlement></list><tree><country name="France"><region name="Île-de-France"><name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name></region><name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name><name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name><name sortKey="Salette, Genevieve" sort="Salette, Genevieve" uniqKey="Salette G" first="Genevieve" last="Salette">Genevieve Salette</name><name sortKey="Steg, Ph Gabriel" sort="Steg, Ph Gabriel" uniqKey="Steg P" first="Ph. Gabriel" last="Steg">Ph. Gabriel Steg</name></country><country name="États-Unis"><region name="New Jersey"><name sortKey="Cohen, Marc" sort="Cohen, Marc" uniqKey="Cohen M" first="Marc" last="Cohen">Marc Cohen</name></region><name sortKey="Steinhubl, Steven R" sort="Steinhubl, Steven R" uniqKey="Steinhubl S" first="Steven R." last="Steinhubl">Steven R. Steinhubl</name></country><country name="Belgique"><noRegion><name sortKey="Desmet, Walter J" sort="Desmet, Walter J" uniqKey="Desmet W" first="Walter J." last="Desmet">Walter J. Desmet</name></noRegion></country><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Macaya, Carlos" sort="Macaya, Carlos" uniqKey="Macaya C" first="Carlos" last="Macaya">Carlos Macaya</name></region></country><country name="Australie"><noRegion><name sortKey="Aylward, Philip E G" sort="Aylward, Philip E G" uniqKey="Aylward P" first="Philip E. G." last="Aylward">Philip E. G. Aylward</name></noRegion></country><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></country><country name="Canada"><region name="Québec"><name sortKey="Gallo, Richard" sort="Gallo, Richard" uniqKey="Gallo R" first="Richard" last="Gallo">Richard Gallo</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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