Percutaneous coronary intervention enoxaparin

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Overview

PCI Approaches:

CAD Revascularization:

Heart Team Approach to Revascularization Decisions
Left Main Coronary Artery Disease
Intervention in left main coronary artery disease
Non-Left Main Coronary Artery Disease
Revascularization to Improve Symptoms
Dual Antiplatelet Therapy Compliance and Stent Thrombosis
Hybrid Coronary Revascularization

Pre-procedural Considerations:

Contrast-Induced Acute Kidney Injury
Anaphylactoid Reactions
Statin Treatment
Bleeding Risk
Role of Onsite Surgical Backup

Procedural Considerations:

Vascular Access
PCI in Specific Clinical Situations:
Asymptomatic Ischemia or CCS Class I or II Angina
CCS Class III Angina
Unstable Angina/Non–ST-Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction:
General and Specific Considerations
Coronary Angiography Strategies in STEMI
Primary PCI of the Infarct Artery
Delayed or Elective PCI in patients with STEMI
Fibrinolytic-Ineligible Patients
Facilitated PCI
Rescue PCI
After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion
Cardiogenic Shock
Prior Coronary Bypass Surgery
Revascularization Before Non-cardiac Surgery
Adjunctive Diagnostic Devices:
Fractional Flow Reserve
Intravascular Ultrasound
Adjunctive Therapeutic Devices:
Coronary Atherectomy
Thrombectomy
Laser Angioplasty
Cutting Balloon Angioplasty
Embolic Protection Devices
Percutaneous Hemodynamic Support Devices
Antiplatelet therapy:
Oral Antiplatelet Therapy
Glycoprotein IIb/IIIa Receptor Antagonists
Intravenous Antiplatelet therapy:
STEMI
UA/NSTEMI
SIHD
Anticoagulant Therapy:
Parenteral Anticoagulants During PCI
Unfractionated Heparin
Enoxaparin
Bivalirudin and Argatroban
Fondaparinux
No-Reflow Pharmacological Therapies
PCI in Specific Anatomic Situations:
Chronic Total Occlusions
Saphenous Vein Grafts
Bifurcation Lesions
Aorto-Ostial Stenoses
Calcified Lesions
PCI in Specific Patient Populations:
Chronic Kidney Disease
Peri-procedural Myocardial Infarction Assessment
Vascular Closure Devices

Post-Procedural Considerations:

Post-procedural Antiplatelet Therapy
Proton Pump Inhibitors and Antiplatelet Therapy
Clopidogrel Genetic Testing
Platelet Function Testing
Restenosis
Exercise Testing
Cardiac Rehabilitation

Quality and Performance Considerations:

Quality and Performance
Certification and Maintenance of Certification
Operator and Institutional Competency and Volume

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1]

Enoxaparin (DO NOT EDIT)[1]

Class I
"1. An additional dose of 0.3 mg/kg intravenous enoxaparin should be administered at the time of PCI to patients who have received fewer than 2 therapeutic subcutaneous doses (e.g., 1 mg/kg) or received the last subcutaneous enoxaparin dose 8 to 12 hours before PCI.[2][3][4][5][6] (Level of Evidence: B)"
Class III (Harm)
"1. Unfractionated heparin (UFH) should not be given to patients already receiving therapeutic subcutaneous enoxaparin.[2][7] (Level of Evidence: B)"
Class IIb
"1. Performance of PCI with enoxaparin may be reasonable in patients either treated with upstream subcutaneous enoxaparin for UA/NSTEMI or who have not received prior antithrombin therapy and are administered intravenous enoxaparin at the time of PCI.[8][9][2][10] (Level of Evidence: B)"

References

  1. 1.0 1.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  2. 2.0 2.1 2.2 Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H (2004). "Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial". JAMA : the Journal of the American Medical Association. 292 (1): 45–54. doi:10.1001/jama.292.1.45. PMID 15238590. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  3. Cohen M, Levine GN, Pieper KS, Lan L, Antman EM, Aylward PE, White HD, Kleiman NS, Califf RM, Mahaffey KW (2010). "Enoxaparin 0.3 mg/kg IV supplement for patients transitioning to PCI after subcutaneous enoxaparin therapy for NSTE ACS: a subgroup analysis from the SYNERGY trial". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 75 (6): 928–35. doi:10.1002/ccd.22340. PMID 20432399. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  4. Collet JP, Montalescot G, Golmard JL, Tanguy ML, Ankri A, Choussat R, Beygui F, Drobinski G, Vignolles N, Thomas D (2004). "Subcutaneous enoxaparin with early invasive strategy in patients with acute coronary syndromes". American Heart Journal. 147 (4): 655–61. doi:10.1016/j.ahj.2003.10.019. PMID 15077081. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  5. Levine GN, Ferrando T (2004). "Degree of anticoagulation after one subcutaneous and one subsequent intravenous booster dose of enoxaparin: implications for patients with acute coronary syndromes undergoing early percutaneous coronary intervention" (PDF). Journal of Thrombosis and Thrombolysis. 17 (3): 167–71. doi:10.1023/B:THRO.0000040484.99422.77. PMID 15353913. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  6. Martin JL, Fry ET, Sanderink GJ, Atherley TH, Guimart CM, Chevalier PJ, Ozoux ML, Pensyl CE, Bigonzi F (2004). "Reliable anticoagulation with enoxaparin in patients undergoing percutaneous coronary intervention: The pharmacokinetics of enoxaparin in PCI (PEPCI) study". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 61 (2): 163–70. doi:10.1002/ccd.10726. PMID 14755805. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  7. Drouet L, Bal dit Sollier C, Martin J (2009). "Adding intravenous unfractionated heparin to standard enoxaparin causes excessive anticoagulation not detected by activated clotting time: results of the STACK-on to ENOXaparin (STACKENOX) study". American Heart Journal. 158 (2): 177–84. doi:10.1016/j.ahj.2009.05.022. PMID 19619692. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  8. Brieger D, Collet JP, Silvain J, Landivier A, Barthélémy O, Beygui F, Bellemain-Appaix A, Mercadier A, Choussat R, Vignolles N, Costagliola D, Montalescot G (2011). "Heparin or enoxaparin anticoagulation for primary percutaneous coronary intervention". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 77 (2): 182–90. doi:10.1002/ccd.22674. PMID 20578166. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  9. Choussat R, Montalescot G, Collet JP, Vicaut E, Ankri A, Gallois V, Drobinski G, Sotirov I, Thomas D (2002). "A unique, low dose of intravenous enoxaparin in elective percutaneous coronary intervention". Journal of the American College of Cardiology. 40 (11): 1943–50. PMID 12475453. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  10. Montalescot G, Gallo R, White HD, Cohen M, Steg PG, Aylward PE, Bode C, Chiariello M, King SB, Harrington RA, Desmet WJ, Macaya C, Steinhubl SR (2009). "Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention 1-year results from the STEEPLE (SafeTy and efficacy of enoxaparin in percutaneous coronary intervention patients, an international randomized evaluation) trial". JACC. Cardiovascular Interventions. 2 (11): 1083–91. doi:10.1016/j.jcin.2009.08.016. PMID 19926048. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)

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