Document Detail


Enoxaparin anticoagulation monitoring in the catheterization laboratory using a new bedside test.
MedLine Citation:
PMID:  20170785     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study evaluated the ability of the bedside test Hemochron Jr. Hemonox (International Technidyne Corporation, Edison, New Jersey) to identify patients with insufficient anti-Xa activity level in the catheterization laboratory. BACKGROUND: Inadequate anticoagulation in patients undergoing percutaneous coronary intervention (PCI) is associated with increased periprocedural ischemic events. METHODS: In 296 unselected patients undergoing catheterization and/or PCI, whole blood Hemonox clotting time (CT) and activated partial thromboplastin time (aPTT) were measured at baseline (T1) and 10 min after the intravenous administration of enoxaparin (T2) in patients receiving additional enoxaparin and compared with plasma chromogenic anti-Xa activity level. RESULTS: Median values were 0.1 IU/ml (interquartile range [IQR]: 0.1 to 0.1 IU/ml) and 0.87 IU/ml (IQR: 0.74 to 1.03 IU/ml) for anti-Xa; 74 s (IQR: 70 to 81 s) and 143 s (IQR: 114 to 206 s) for Hemonox CT; and 44 s (IQR: 39 to 50 s) and 72 s (IQR: 58 to 93 s) for aPTT at T1 and T2, respectively. When using Hemonox CT to discriminate patients with anti-Xa level <0.5 IU/ml, the area under the receiver operating characteristic curve was 0.95 +/- 0.01 (95% confidence interval [CI]: 0.93 to 0.97) versus 0.89 +/- 0.01 (95% CI: 0.86 to 0.92) for aPTT. The threshold value of 120 s was associated with a 94.9% (95% CI: 91.1% to 97.4%) sensitivity and a 73.3% (95% CI: 67.6% to 78.5%) specificity to detect patients with inadequate anti-Xa level (<0.5 IU/ml) and positive predictive and negative predictive values of 73.9% (95% CI: 68.7% to 79.0%) and 94.78% (95% CI: 91.8% to 97.8%), respectively. CONCLUSIONS: Hemonox CT appears to be a fast and reliable bedside test for detecting patients insufficiently anticoagulated and needing adjustment of anticoagulation therapy with enoxaparin before PCI.
Authors:
Johanne Silvain; Farzin Beygui; Annick Ankri; Anne Bellemain-Appaix; Ana Pena; Olivier Barthelemy; Guillaume Cayla; Vanessa Gallois; Sophie Galier; Dominique Costagliola; Jean-Philippe Collet; Gilles Montalescot
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2010-03-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  617-25     Citation Subset:  AIM; IM    
Affiliation:
Institut de Cardiologie, Institut National de la Sant? et de la Recherche M?dicale (INSERM) CMR937, Piti?-Salp?tri?re Hospital (AP-HP), Universit? Paris 6, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Anticoagulants / administration & dosage*
Blood Coagulation Tests / instrumentation*
Drug Monitoring / instrumentation*
Enoxaparin / administration & dosage*
Factor Xa / analysis,  antagonists & inhibitors
Female
Heart Catheterization
Humans
Likelihood Functions
Male
Middle Aged
Obesity / blood
Partial Thromboplastin Time
Point-of-Care Systems*
Predictive Value of Tests
ROC Curve
Renal Insufficiency / blood
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Enoxaparin; EC 3.4.21.6/Factor Xa

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