Cavusoglu Erdal, Lakhani Manish, Marmur Jonathan D
Division of Cardiology, Department of Medicine, the Bronx Veterans Administration Medical Center, Bronx, NY, USA.
J Invasive Cardiol. 2005 Aug;17(8):416-21.
The use of low-molecular weight heparin (LMWH) during percutaneous coronary intervention (PCI) has been limited by the presumed inability to monitor its anticoagulant effect using bedside assays.
This study was designed to compare the dose-response of enoxaparin, dalteparin and unfractionated heparin (UFH) on the activated clotting time (ACT), and to determine whether the ACT or aPTT can be used to monitor intravenous (IV) low molecular weight heparin (LMWH).
A total of 130 patients undergoing cardiac catheterization were assigned to intravenous enoxaparin 0.5 mg/kg, dalteparin 50 international units/kg or UFH 50 units/kg. Of the 130 patients, 46 (35%) underwent PCI, all of whom received a glycoprotein (GP) IIb/IIIa inhibitor. We measured ACT, activated partial thromboplastin time (aPTT) and plasma anti-Xa levels after serial sampling.
Both enoxaparin and dalteparin induced a significant rise in the ACT and aPTT, with an ACT dose-response approximately one-half the magnitude of that obtained using UFH. The time course of changes in the ACT and aPTT after administration of enoxaparin and dalteparin was virtually identical, with a return to baseline at approximately 2 hours. The enoxaparin and dalteparin-treated patients successfully underwent PCI with no major hemorrhagic complications.
The ACT is equally sensitive to IV enoxaparin and dalteparin. These data support an ACT-guided strategy for intravenously administered LMWH during PCI. Additional studies with larger patient populations may be indicated to determine the ideal target ACT for LMWH in PCI.
在经皮冠状动脉介入治疗（PCI）期间，低分子量肝素（LMWH）的使用受到限制，原因是人们认为无法使用床旁检测方法监测其抗凝效果。
本研究旨在比较依诺肝素、达肝素和普通肝素（UFH）对活化凝血时间（ACT）的剂量反应，并确定ACT或活化部分凝血活酶时间（aPTT）是否可用于监测静脉注射（IV）低分子量肝素（LMWH）。
总共130例接受心导管检查的患者被分配接受静脉注射依诺肝素0.5mg/kg、达肝素50国际单位/kg或UFH 50单位/kg。在这130例患者中，46例（35%）接受了PCI，所有这些患者均接受了糖蛋白（GP）IIb/IIIa抑制剂治疗。我们在连续采样后测量了ACT、活化部分凝血活酶时间（aPTT）和血浆抗Xa水平。
依诺肝素和达肝素均使ACT和aPTT显著升高，ACT的剂量反应约为使用UFH时的一半。依诺肝素和达肝素给药后ACT和aPTT的变化时间过程几乎相同，约2小时后恢复至基线水平。接受依诺肝素和达肝素治疗的患者成功接受了PCI，无重大出血并发症。
ACT对静脉注射依诺肝素和达肝素同样敏感。这些数据支持在PCI期间采用ACT指导的策略来静脉注射LMWH。可能需要进行更多有更大患者群体的研究，以确定PCI中LMWH的理想ACT目标值。
