Prolonged Enoxaparin In Primary Percutaneous Coronary Intervention; A Pilot Pharmacodynamic Study
Status:
Completed
Trial end date:
2018-03-30
Target enrollment:
Participant gender:
Summary
Heart attacks are caused by a clot blocking one or more of the heart arteries (coronary
arteries). When complete blockage of one of the arteries occurs, emergency treatment to
unblock the affected artery and rescue the heart muscle at risk is essential. This is usually
achieved by performing an emergency procedure called primary percutaneous coronary
intervention (PPCI).
Anticlotting treatment is also necessary to reduce the chances of further heart attacks. As
part of standard care, tablets that target small cells called platelets (central to blood
clot formation) are given as soon as an acute heart attack is suspected. These tablets
include aspirin and ticagrelor/prasufrel. Although both ticgrelor and prasugrel are
effective, the onset of action is delayed by up to 8 hours when given in context of an acute
heart attack. This delay in onset of action can increase the risk of further heart attacks.
Enoxaparin is an anticlotting treatment that targets the other aspect of clot formation known
as coagulation cascade. Enoxaparin or an alternative is recommended as a single does to
support the PPCI procedure. The effects of a single shot of enoxaparin do not last long
enough to bridge the gap in anticlotting treatment caused by the delayed action of
ticagrelor/prasugrel. Since the investigators have realised the delayed onset of action of
tablet therapy, the investigators have been using another drug called tirofiban as a drip.
Tirofiban blocks platelets effectively, but greatly increases the risk of bleeding events.
The investigators believe that giving enoxaparin as a drip for 3-6 hours (following the
single dose) instead of tirofiban, would be sufficient to bridge the gap in anticlotting
effect without greatly increasing the risk of bleeding. This is a pilot study to assess the
effects of enoxaparin drip in patients presenting with acute heart attacks and undergoing
emergency treatment with PPCI.