Pharmacokinetics of intravenous/subcutaneous Enoxaparin in patients with acute coronary syndrome undergoing percutaneous coronary interventions

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Abstract
Plasma anti‐Xa activity after Enoxaparin administration in patients with acute coronary syndrome (ACS) undergoing coronary angiography and percutaneous coronary intervention (PCI) has not been well established. Patients presenting with non–ST‐elevation ACS received an initial dose (0.75 mg/kg) of Enoxaparin intravenously (IV), with subsequent doses (1 mg/kg) subcutaneously (SC) beginning 8 hr following the IV dose. Patients who underwent PCI within 4 hr of the IV dose or 8 hr of the SC dose did not receive additional Enoxaparin. All others received 0.3–0.4 mg/kg additional IV Enoxaparin at the time of PCI. All patients undergoing PCI received a glycoprotein IIb/IIIa inhibitor and clopidogrel. Mean plasma anti‐Xa activity (units/ml) 10 min and 2, 4, 6, and 8 hr after IV dose was 2.29 ± 0.39, 0.99 ± 0.29, 0.58 ± 0.14, 0.36 ± 0.13, 0.24 ± 0.11, respectively. Mean Plasma anti‐Xa activity 2, 4, 6, 8, 10, and 12 hr after SC dose was 1.01 ± 0.22, 1.13 ± 0.27, 1.1 ± 0.41, 0.84 ± 0.19, 0.62 ± 0.24, and 0.46 ± 0.21, respectively. Mean plasma anti‐Xa activity at the start and end of PCI was 1.27 ± 0.41 and 1.07 ± 0.42, respectively. In conclusion, adequate anticoagulation with Enoxaparin may be achieved within 10 min after an IV dose of 0.75 mg/kg. High‐risk ACS patients requiring urgent PCI may benefit from this approach. PCI may be performed without additional anticoagulation within 4 hr of IV or 8 hr of SC Enoxaparin. PCI 4–8 hr after IV dose or 8–12 hr after SC dose will require additional IV Enoxaparin 0.3–0.4 mg/kg to ensure therapeutic anti‐Xa activity. Cathet Cardiovasc Intervent 2002;57:187–190.