| Title: |
Pharmacodynamic Effects of a 6-Hour Regimen of Enoxaparin in Patients Undergoing Primary Percutaneous Coronary Intervention (PENNY PCI Study) |
| Authors: |
Sumaya, W; Parker, WAE; Fretwell, R; Hall, IR; Barmby, DS; Richardson, JD; Iqbal, J; Adam, Z; Morgan, KP; Gunn, JP; Mason, AE; Judge, HM; Gale, CP; Ajjan, RA; Storey, RF |
| Publisher Information: |
Thieme Publishing |
| Publication Year: |
2018 |
| Collection: |
White Rose Research Online (Universities of Leeds, Sheffield & York) |
| Description: |
Delayed onset of action of oral P2Y₁₂ inhibitors in ST-elevation myocardial infarction (STEMI) patients may increase the risk of acute stent thrombosis. Available parenteral anti-thrombotic strategies, to deal with this issue, are limited by added cost and increased risk of bleeding. We investigated the pharmacodynamic effects of a novel regimen of enoxaparin in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Twenty patients were recruited to receive 0.75 mg/kg bolus of enoxaparin (pre-PPCI) followed by infusion of enoxaparin 0.75 mg/kg/6 h. At four time points (pre-anti-coagulation, end of PPCI, 2–3 hours into infusion and at the end of infusion), anti-Xa levels were determined using chromogenic assays, fibrin clots were assessed by turbidimetric analysis and platelet P2Y₁₂ inhibition was determined by VerifyNow P2Y₁₂ assay. Clinical outcomes were determined 14 hours after enoxaparin initiation. Nineteen of 20 patients completed the enoxaparin regimen; one patient, who developed no-reflow phenomenon, was switched to tirofiban after the enoxaparin bolus. All received ticagrelor 180 mg before angiography. Mean (± standard error of the mean) anti-Xa levels were sustained during enoxaparin infusion (1.17 ± 0.06 IU/mL at the end of PPCI and 1.003 ± 0.06 IU/mL at 6 hours), resulting in prolonged fibrin clot lag time and increased lysis potential. Onset of platelet P2Y₁₂ inhibition was delayed in opiate-treated patients. No patients had thrombotic or bleeding complications. In conclusion, enoxaparin 0.75 mg/kg bolus followed by 0.75 mg/kg/6 h provides sustained anti-Xa levels in PPCI patients. This may protect from acute stent thrombosis in opiate-treated PPCI patients who frequently have delayed onset of oral P2Y₁₂ inhibition. |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| ISSN: |
0340-6245 |
| Relation: |
https://eprints.whiterose.ac.uk/id/eprint/137622/1/published%20paper.pdf; Sumaya, W, Parker, WAE, Fretwell, R et al. (12 more authors) (2018) Pharmacodynamic Effects of a 6-Hour Regimen of Enoxaparin in Patients Undergoing Primary Percutaneous Coronary Intervention (PENNY PCI Study). Thrombosis and Haemostasis, 118 (07). pp. 1250-1256. ISSN: 0340-6245 |
| Availability: |
https://eprints.whiterose.ac.uk/id/eprint/137622/; https://eprints.whiterose.ac.uk/id/eprint/137622/1/published%20paper.pdf |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.26A0AF99 |
| Database: |
BASE |