부산대학교 도서관

Introduction:Strategies are needed to circumvent the delayed absorption of oral P2Y12 inhibitors in opiate-treated patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). A novel enoxaparin regimen, consisting of an intra-arterial bolus (0.75 mg/kg) followed by an intravenous infusion (0.75 mg/kg/6h), has been shown to provide sustained antithrombotic effects over 6 hours following PPCI.Hypothesis:Enoxaparin (0.75mg/kg bolus + 0.75mg/kg/6h) is a feasible alternative to standard-of-care treatment (SOC) with unfractionated heparin +/- glycoprotein IIb/IIIa antagonist (GPI).Methods:100 opiate-treated patients presenting with STEMI and accepted for PPCI were randomized (1:1) to either enoxaparin or SOC. Clinical outcomes were determined at 24 hours and 30 days. ST-segment resolution was determined within 1 hour of PPCI.Results:50 patients were allocated enoxaparin (median age 61, 40% females) and 49 allocated SOC (median age 62, 22% females). One developed stroke before angiography and was withdrawn. 40/49 SOC patients received GPI and 3/50 enoxaparin patients were switched to GPI for no re-flow. Two SOC and no enoxaparin group patients had acute stent thrombosis. One SOC patient had a gastrointestinal bleed resulting in 1g hemoglobin drop and early cessation of tirofiban infusion. Two enoxaparin patients had minor bleeding: one transient gingival bleed and one episode of coffee ground vomit with no hemoglobin drop or hemodynamic instability. ST-segment resolution was not significantly different between the two groups (P = 0.44) (Figure). Two patients died within 30 days; one in the SOC arm, following an acute stent thrombosis, and one in the enoxaparin arm due to left ventricular failure.Conclusions:A novel enoxaparin regimen (0.75 mg/kg bolus + 0.75 mg/kg/6h) in opiate-treated PPCI patients appears to be safe. These preliminary data support larger studies of this regimen.