Early ambulation and variability in anticoagulation during elective coronary stenting with a single intravenous bolus of low-dose, low-molecular weight heparin enoxaparin

Abstract

Background: The best anticoagulation strategy for patients undergoing percutaneous coronary intervention (PCI) remains controversial. The primary objective of this study was to assess the feasibility of immediate sheath removal post-PCI in patients given a single low-dose intravenous (IV) bolus of enoxaparin as the sole anticoagulant.

Methods: In 53 patients with stable coronary disease undergoing elective PCI, a single IV bolus of 0.5 mg per kg enoxaparin was administered 10 minutes before PCI. Patients were pretreated with aspirin 100 mg and clopidogrel 300 mg. The femoral access sheaths were removed immediately after PCI by manual compression. Major and minor bleeding and coronary thrombosis were recorded. Anti-Xa levels were measured before, during and after PCI.

Results: One patient had an intracoronary thrombus 60 minutes after enoxaparin administration, and there was 1 ischemic stroke. Fifty-one of the 53 patients had their sheaths successfully pulled immediately post-PCI. One patient had a pseudoaneurysm requiring surgical repair, and 1 patient had a minor bleed. Postprocedural elevation of CK-MB > 3 times the upper limit of normal occurred in 7 patients (13.2%). Anti-Xa activity was 0.56 +/- 0.16 at 10 minutes post-IV injection, and then progressively decreased to 0.14 +/- 0.09 IU/ml at 6 hours after injection. Ten minutes after IV enoxaparin, 12 patients (23.5%) had anti-Xa levels < 0.5 IU/ml.

Conclusions: Immediate removal of femoral sheaths, after a single low-dose of IV enoxaparin for elective stenting appears feasible. However, a sizeable proportion of patients achieved anti-Xa levels below the widely agreed upon "therapeutic" level after injection.