Effect of different doses of enoxaparin combined with ticagrelor on clinical events in patients with non-ST-elevation acute coronary syndrome and complex coronary artery lesions after percutaneous coronary intervention / 中国介入心脏病学杂志

ABSTRACT

Objective To explore the safety and efficacy of different doses of enoxaparin combined with ticagrelor after percutaneous coronary intervention (PCI) in patients with non-ST elevation-acute coronary syndrome (NSTE-ACS) and complex coronary artery lesions and try to find out the best combination dose of enoxaparin. Methods A total of 345 NSTE-ACS patients with complex coronary artery lesions that had undergone percutaneous coronary intervention were recruited in Beijing Anzhen Hospital affi liated to Capital University from March 2015 to October 2016. All patients were treated with aspirin and ticagrelor during the trial and randomly assigned to three groups no enoxaparin anticoagulation therapy (non-anticoagulation group), half dose of enoxaparin anticoagulation therapy (0.5 mg / kg, half-anticoagulation group) and full dose of enoxaparin anticoagulation therapy (1 mg / kg) (total-anticoagulation group).The primary endpoints were bleeding events during hospitalization and at 12 months after PCI and the secondary endpoints were major adverse cardiac and cerebrovascular events (MACCEs) during hospitalization and at 1, 3 and 12 months after PCI. Results (1) The primary endpoints The incidences of total bleeding events in patients treated with full dose of enoxaparin were signifi cantly higher than those in the non-anticoagulation group(29.5%vs.13.6%,P=0.005)and the two groups had comparable rates of major bleeding(1.9%vs. 0,P>0.05),but minor bleeding rates were higher in the total-anticoagulation group(27.6% vs.13.6%, P=0.012).There were no significant differences in the incidence of major and minor bleeding events between the half-anticoagulation and the non-anticoagulation groups during hospitalization (all P>0.05). Trend test showed that the incidence of total bleeding and minor bleeding were increased with the increase of the dose of enoxaparin after PCI, and there was a linear correlation between bleeding events and dose of enoxaparin (total bleeding trend for P=0.005; minor bleeding trend for P=0.011). (2) The secondary endpoints there was no signifi cant diff erence in the incidence of perioperative myocardial injury and MACCE at 1 month, 3 months and 12 months post-PCI between three groups (P>0.05).Conclusions For NSTE-ACS patients with complex coronary lesions, the combination of ticagrelor and enoxaparin after PCI did not bring additional benefi ts. Subcutaneous application of full dose of enoxaparin may increase patients' bleeding risk after PCI, while reduced dose of enoxaparin is relatively safe. These results suggest that routine anticoagulation therapy after PCI is not necessary for patients with NSTE-ACS and complex coronary lesions who were treated with ticagrelor. Reduced dose of enoxaparin could be applied subcutaneously post PCI after fully assessing the ischemia and bleeding risk of patients if it is necessary.