Comparison of Anticoagulant and Anti-Inflammatory Responses Using Enoxaparin Versus Unfractionated Heparin for Transesophageal Echocardiography-Guided Cardioversion of Atrial Fibrillation
The Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) II study compared enoxaparin with unfractionated heparin (UFH) as bridging therapy in patients with atrial fibrillation >2 days in duration who underwent transesophageal echocardiography-guided cardioversion. In the pr...
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| creator | Hoppensteadt, Debra, PhD Fareed, Jawed, PhD Klein, Allan L., MD Jasper, Susan E., BSN Apperson-Hansen, Carolyn, MStat Lieber, Elizabeth A., BA Katz, William E., MD Malouf, Joseph F., MD Stoddard, Marcus F., MD Pape, Linda A., MD |
| description | The Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) II study compared enoxaparin with unfractionated heparin (UFH) as bridging therapy in patients with atrial fibrillation >2 days in duration who underwent transesophageal echocardiography-guided cardioversion. In the present study, the anticoagulant and anti-inflammatory effects of enoxaparin and UFH were compared at prespecified time points. In a randomized substudy of 155 patients from 17 clinical sites, the anticoagulant activity of enoxaparin (n = 76) was compared with that of UFH (n = 79). Blood samples were drawn at enrollment, on day 2, and on day 4 in the 2 groups. Blood samples were evaluated for anticoagulant activity by measuring the activated partial thromboplastin time, anti-Xa, anti-IIa, and tissue factor pathway inhibitor levels. In addition, levels of coagulation activation (by thrombin antithrombin complex) and inflammation (by highly sensitive C-reactive protein) were measured. The results of this substudy showed that the anti-Xa levels in the 2 groups increased on day 2. Similar increases in anti-Xa were observed on day 4. The anti-Xa levels and tissue factor pathway inhibitor levels were higher in the enoxaparin group compared with the UFH group on days 2 and 4. However, as expected, the anti-IIa levels in the UFH group were higher. In addition, markers of coagulation activation and inflammation were increased in patients with atrial fibrillation. Treatment with enoxaparin significantly decreased thrombin antithrombin complex levels compared with treatment with UFH. Highly sensitive C-reactive protein levels were also decreased after treatment in the 2 groups. In conclusion, the ACUTE II study showed that the use of enoxaparin for bridging therapy in patients with atrial fibrillation who underwent transesophageal echocardiography-guided cardioversion resulted in a more predictable and stronger anticoagulant response than that observed with UFH. Markers of inflammation were also decreased in the 2 groups. |
| doi_str_mv | 10.1016/j.amjcard.2008.05.025 |
| format | Article |
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In the present study, the anticoagulant and anti-inflammatory effects of enoxaparin and UFH were compared at prespecified time points. In a randomized substudy of 155 patients from 17 clinical sites, the anticoagulant activity of enoxaparin (n = 76) was compared with that of UFH (n = 79). Blood samples were drawn at enrollment, on day 2, and on day 4 in the 2 groups. Blood samples were evaluated for anticoagulant activity by measuring the activated partial thromboplastin time, anti-Xa, anti-IIa, and tissue factor pathway inhibitor levels. In addition, levels of coagulation activation (by thrombin antithrombin complex) and inflammation (by highly sensitive C-reactive protein) were measured. The results of this substudy showed that the anti-Xa levels in the 2 groups increased on day 2. Similar increases in anti-Xa were observed on day 4. The anti-Xa levels and tissue factor pathway inhibitor levels were higher in the enoxaparin group compared with the UFH group on days 2 and 4. However, as expected, the anti-IIa levels in the UFH group were higher. In addition, markers of coagulation activation and inflammation were increased in patients with atrial fibrillation. Treatment with enoxaparin significantly decreased thrombin antithrombin complex levels compared with treatment with UFH. Highly sensitive C-reactive protein levels were also decreased after treatment in the 2 groups. In conclusion, the ACUTE II study showed that the use of enoxaparin for bridging therapy in patients with atrial fibrillation who underwent transesophageal echocardiography-guided cardioversion resulted in a more predictable and stronger anticoagulant response than that observed with UFH. Markers of inflammation were also decreased in the 2 groups.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2008.05.025</identifier><identifier>PMID: 18805108</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier</publisher><subject>Antithrombin III ; Atrial Fibrillation - therapy ; Biological and medical sciences ; Biomarkers - blood ; Bones, joints and connective tissue. Antiinflammatory agents ; C-Reactive Protein - analysis ; Cardiac arrhythmia ; Cardiac dysrhythmias ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular system ; Echocardiography, Transesophageal ; Electric Countershock - methods ; Enoxaparin - therapeutic use ; Feasibility Studies ; Female ; Fibrinolytic Agents - therapeutic use ; Heart ; Heparin - therapeutic use ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Lipoproteins - blood ; Male ; Medical sciences ; Middle Aged ; Partial Thromboplastin Time ; Peptide Hydrolases - blood ; Pharmacology. Drug treatments ; Pilot Projects ; Prospective Studies ; Proteins ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Studies ; Treatment Outcome ; Ultrasonic investigative techniques ; Ultrasonography, Interventional</subject><ispartof>The American journal of cardiology, 2008-10, Vol.102 (7), p.842-846</ispartof><rights>Elsevier Inc.</rights><rights>2008 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Oct 1, 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20708377$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18805108$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hoppensteadt, Debra, PhD</creatorcontrib><creatorcontrib>Fareed, Jawed, PhD</creatorcontrib><creatorcontrib>Klein, Allan L., MD</creatorcontrib><creatorcontrib>Jasper, Susan E., BSN</creatorcontrib><creatorcontrib>Apperson-Hansen, Carolyn, MStat</creatorcontrib><creatorcontrib>Lieber, Elizabeth A., BA</creatorcontrib><creatorcontrib>Katz, William E., MD</creatorcontrib><creatorcontrib>Malouf, Joseph F., MD</creatorcontrib><creatorcontrib>Stoddard, Marcus F., MD</creatorcontrib><creatorcontrib>Pape, Linda A., MD</creatorcontrib><creatorcontrib>Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) II Investigators</creatorcontrib><title>Comparison of Anticoagulant and Anti-Inflammatory Responses Using Enoxaparin Versus Unfractionated Heparin for Transesophageal Echocardiography-Guided Cardioversion of Atrial Fibrillation</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) II study compared enoxaparin with unfractionated heparin (UFH) as bridging therapy in patients with atrial fibrillation >2 days in duration who underwent transesophageal echocardiography-guided cardioversion. In the present study, the anticoagulant and anti-inflammatory effects of enoxaparin and UFH were compared at prespecified time points. In a randomized substudy of 155 patients from 17 clinical sites, the anticoagulant activity of enoxaparin (n = 76) was compared with that of UFH (n = 79). Blood samples were drawn at enrollment, on day 2, and on day 4 in the 2 groups. Blood samples were evaluated for anticoagulant activity by measuring the activated partial thromboplastin time, anti-Xa, anti-IIa, and tissue factor pathway inhibitor levels. In addition, levels of coagulation activation (by thrombin antithrombin complex) and inflammation (by highly sensitive C-reactive protein) were measured. The results of this substudy showed that the anti-Xa levels in the 2 groups increased on day 2. Similar increases in anti-Xa were observed on day 4. The anti-Xa levels and tissue factor pathway inhibitor levels were higher in the enoxaparin group compared with the UFH group on days 2 and 4. However, as expected, the anti-IIa levels in the UFH group were higher. In addition, markers of coagulation activation and inflammation were increased in patients with atrial fibrillation. Treatment with enoxaparin significantly decreased thrombin antithrombin complex levels compared with treatment with UFH. Highly sensitive C-reactive protein levels were also decreased after treatment in the 2 groups. In conclusion, the ACUTE II study showed that the use of enoxaparin for bridging therapy in patients with atrial fibrillation who underwent transesophageal echocardiography-guided cardioversion resulted in a more predictable and stronger anticoagulant response than that observed with UFH. Markers of inflammation were also decreased in the 2 groups.</description><subject>Antithrombin III</subject><subject>Atrial Fibrillation - therapy</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Bones, joints and connective tissue. Antiinflammatory agents</subject><subject>C-Reactive Protein - analysis</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular system</subject><subject>Echocardiography, Transesophageal</subject><subject>Electric Countershock - methods</subject><subject>Enoxaparin - therapeutic use</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Heart</subject><subject>Heparin - therapeutic use</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Lipoproteins - blood</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Partial Thromboplastin Time</subject><subject>Peptide Hydrolases - blood</subject><subject>Pharmacology. Drug treatments</subject><subject>Pilot Projects</subject><subject>Prospective Studies</subject><subject>Proteins</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. 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Antiinflammatory agents</topic><topic>C-Reactive Protein - analysis</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular system</topic><topic>Echocardiography, Transesophageal</topic><topic>Electric Countershock - methods</topic><topic>Enoxaparin - therapeutic use</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Heart</topic><topic>Heparin - therapeutic use</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Lipoproteins - blood</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Partial Thromboplastin Time</topic><topic>Peptide Hydrolases - blood</topic><topic>Pharmacology. 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In the present study, the anticoagulant and anti-inflammatory effects of enoxaparin and UFH were compared at prespecified time points. In a randomized substudy of 155 patients from 17 clinical sites, the anticoagulant activity of enoxaparin (n = 76) was compared with that of UFH (n = 79). Blood samples were drawn at enrollment, on day 2, and on day 4 in the 2 groups. Blood samples were evaluated for anticoagulant activity by measuring the activated partial thromboplastin time, anti-Xa, anti-IIa, and tissue factor pathway inhibitor levels. In addition, levels of coagulation activation (by thrombin antithrombin complex) and inflammation (by highly sensitive C-reactive protein) were measured. The results of this substudy showed that the anti-Xa levels in the 2 groups increased on day 2. Similar increases in anti-Xa were observed on day 4. The anti-Xa levels and tissue factor pathway inhibitor levels were higher in the enoxaparin group compared with the UFH group on days 2 and 4. However, as expected, the anti-IIa levels in the UFH group were higher. In addition, markers of coagulation activation and inflammation were increased in patients with atrial fibrillation. Treatment with enoxaparin significantly decreased thrombin antithrombin complex levels compared with treatment with UFH. Highly sensitive C-reactive protein levels were also decreased after treatment in the 2 groups. In conclusion, the ACUTE II study showed that the use of enoxaparin for bridging therapy in patients with atrial fibrillation who underwent transesophageal echocardiography-guided cardioversion resulted in a more predictable and stronger anticoagulant response than that observed with UFH. Markers of inflammation were also decreased in the 2 groups.</abstract><cop>New York, NY</cop><pub>Elsevier</pub><pmid>18805108</pmid><doi>10.1016/j.amjcard.2008.05.025</doi><tpages>5</tpages></addata></record> |
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| subjects | Antithrombin III Atrial Fibrillation - therapy Biological and medical sciences Biomarkers - blood Bones, joints and connective tissue. Antiinflammatory agents C-Reactive Protein - analysis Cardiac arrhythmia Cardiac dysrhythmias Cardiology Cardiology. Vascular system Cardiovascular Cardiovascular system Echocardiography, Transesophageal Electric Countershock - methods Enoxaparin - therapeutic use Feasibility Studies Female Fibrinolytic Agents - therapeutic use Heart Heparin - therapeutic use Humans Investigative techniques, diagnostic techniques (general aspects) Lipoproteins - blood Male Medical sciences Middle Aged Partial Thromboplastin Time Peptide Hydrolases - blood Pharmacology. Drug treatments Pilot Projects Prospective Studies Proteins Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Studies Treatment Outcome Ultrasonic investigative techniques Ultrasonography, Interventional |
| title | Comparison of Anticoagulant and Anti-Inflammatory Responses Using Enoxaparin Versus Unfractionated Heparin for Transesophageal Echocardiography-Guided Cardioversion of Atrial Fibrillation |
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