Comparative laboratory effectiveness of low molecular weight heparins in patients with acute coronary syndrome and no ST segment elevation
Abstract
Aim. To compare anti-Xa plasma activity levels in patients with acute coronary syndrome (ACS) and no ST segment elevation (non-STE ACS), receiving enoxaparin, nadroparin, or dalteparin.
Material and methods. In total, 90 patients with non-STE ACS were divided into three groups (n=30 in each group), by the type of low molecular weight heparin (LMWH) administered. All groups were comparable by age and gender structure, body mass index, and creatinine clearance levels. Anti-Xa activity was measured at admission and 6 hours after the first LMWH injection.
Results. In all groups, anti-Xa activity was significantly increased at 6 hours after the first LMWH injection. At the end of the follow-up period, the change in this parameter was 0,73±0,11 IU/ml, with baseline level of 0,07±0,05 IU/ml, in the enoxaparin group. In the dalteparin group, the respective values were 0,52±0,12 and 0,05±0,03 IU/ ml, and in the nadroparin group, they were 0,61±0,10 and 0,06±0,05 IU/ml, respectively. The percentage of patients with achieved therapeutic anti-Xa activity (≥0,6 IU/ml) was maximal in the enoxaparin group (93%), being significantly higher than in the dalteparin and nadroparin groups (63% and 77%, respectively).
Conclusion. Enoxaparin, dalteparin, and nadroparin therapy in non-STE ACS patients was associated with significantly increased plasma anti-Xa activity. However, the percentage of the patients with achieved therapeutic levels of anti-Xa activity was maximal in the enoxaparin group.
About the Authors
R. M. Linchak
N.I. Pirogov National Medico-Surgical Centre
Russian Federation
Moscow
Russian Federation
Moscow
V. S. Popov
N.I. Pirogov National Medico-Surgical Centre
Russian Federation
Moscow
Russian Federation
Moscow
K. F. Kim
N.I. Pirogov National Medico-Surgical Centre
Russian Federation
Moscow
Russian Federation
Moscow
References
1. Общая заболеваемость взрослого населения (18 лет и старше) по классам болезней за 2000-2004 гг. Российская Федерация. Министерство здравоохранения и социального развития РФ.
2. Чазов Е.И., Бойцов С.А. Пути снижения сердечно-сосудистой смертности в стране. Кардиол вестник 2009; 1 (4): 5-10.
3. Зайратьянц О.В. Анализ смертности, летальности, числа аутопсий и качества клинической диагностики в Москве за последнее десятилетие (1991-2000). Арх патол 2002; Приложение.
4. Руда М.Я. О системе лечения больных с острым коронарным синдромом. Кардиол вестник 2006; 2(1): 5-10.
5. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update). A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2009; 120: 2271-306.
6. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes, The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology, 2007.
7. Eikelboom JW, Anand SS, Malmberg K, et al. Unfractionated heparin and low-molecular-weight heparin in acute coronary syndrome without ST elevation: a meta-analysis. Lancet 2000; 355: 1936-42.
8. Petersen JL, Mahaffey KW, Hasselblad V, et al. Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-segment elevation acute coronary syndrome: a systematic overview. JAMA 2004; 292: 89-96.
9. Al-Sallami HS, Barras MA, Green B, Duffull SB. Routine Plasma Anti-Xa Monitoring is Required for Low-MolecularWeight Heparins. Clin Pharmacokinet 2010; 49(9): 567-71.
10. Al-Sallami HS, Jordan S, Ferguson R, et al. Current enoxaparin dosing guidelines have dubious credibility. Ther Drug Monit 2010; 35: 24-9.
11. Рекомендации по диагностике и лечению больных с острым коронарным синдромом без стойкой элевации сегмента ST. Всероссийское научное общество кардиологов 2006.
12. ACC/AHA Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction, 2007.
13. Вавилова Т.В. Антитромботическая терапия и методы ее лабораторного контроля. Клин лаб диагностика 2004; 12: 21-32.
14. Klein W, Buchwald A, Hillis SE, et al. Comparison of lowmolecular-weight heparin with unfractionated heparin acutely and with placebo for 6 weeks in the management of unstable coronary artery disease. Fragmin in unstable coronary artery disease study (FRIC). Circulation 1997; 96: 61-8.
15. The FRAX.I.S. Study Group. Comparison of two treatment durations (6 days and 14 days) of low molecular weight heparin with a 6-day treatment of unfractionated heparin in the initial management of unstable angina or non-Q-wave myocardial infarction: FRAX.I.S. (FRAxiparine in Ischemic Syndrome). Eur Heart J 1999; 20: 1553-62.
16. Ostadal P, Alan D, Vejvoda J, et al. Anti-Xa activity of enoxaparin and nadroparin in patients with acute coronary syndrome. Exp Clin Cardiol 2008; 13(4): 175-8.
17. Collignon F, Frydman A, Caplain H, et al. Comparison of the pharmacokinetic profiles of three low molecular mass heparins — dalteparin, enoxaparin, and nadroparin — administered subcutaneously in healthy volunteers (doses for prevention of thromboembolism). Thromb Haemost 1995; 73(4): 630-40.
18. Naumnik B, Rydzewska-Rosolowska A, Mysliwiec M. Different Effects of Enoxaparin, Nadroparin, and Dalteparin on Plasma TFPI During Hemodialysis: A Prospective Crossover Randomized Study. Clin Appl Thromb Hemost 2010; 16 (5): 574-8.
19. Priglinger U, Delle Karth G, Geppert A, et al. Prophylactic anticoagulation with enoxaparin: Is the subcutaneous route appropriate in the critically ill? Crit Care Med 2003; 31(5): 1405-9.
20. Dorffler-Melly J, de Jonge E, Pont AC, et al. Bioavailability of subcutaneous low-molecular-weight heparin to patients on vasopressors. Lancet 2002; 359 (9309): 849-50.
21. Linhardt RJ, Loganathan D, Al-Hakim A, et al. Oligosaccharide mapping of low molecular weight heparins: Structure and activity differences J Med Chem 1990; 33: 1639-45.
22. Jack Hirsh MD. Low Molecular Weight Heparins. Fourth Edition 2007.
23. Weitz J. Low-molecular-weight heparins. N Engl J Med 1997; 337: 688-98.
24. Linhardt R, Gunay N. Production and chemical processing of low molecular weight heparin. Semin Thromb Hemost 1999; 25 (Suppl. 3): 5-16.
25. Adiguzel C, Jeske W, Hoppensteadt D, et al. Structural and functional characterization of low-molecular-weight heparins: impact on the development of guidelines for generic products. Clin Appl Thromb Hemost 2009; 15: 137-44.
26. Jeske W, Walenga J, Hoppensteadt D, et al. Differentiating lowmolecular weight heparins based on chemical, biological, and pharmacologic properties: implications for the development of generic versions of low-molecular-weight heparins. Semin Thromb Hemost 2008; 34: 74-85.
Review
For citations:
Linchak R.M., Popov V.S., Kim K.F. Comparative laboratory effectiveness of low molecular weight heparins in patients with acute coronary syndrome and no ST segment elevation. Cardiovascular Therapy and Prevention. 2011;10(1):53-58. (In Russ.)
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