A unique, low dose of intravenous enoxaparin in elective percutaneous coronary intervention

AbstractObjectivesThis study was designed to examine a unique and low dose of intravenous enoxaparin in elective percutaneous coronary intervention (PCI) that would be applicable to an unselected population regardless of age, weight, renal function, or use of glycoprotein IIb/IIIa inhibitors.BackgroundThere is limited experience of anticoagulation using intravenous (IV) low-molecular-weight heparin in PCI, which has been obtained with high doses causing elevated anticoagulation levels and delayed sheath withdrawal.MethodsA total of 242 consecutive patients undergoing elective PCI were treated with a single IV bolus of enoxaparin (0.5 mg/kg), and 26% of patients (n = 64) also received eptifibatide. Sheaths were removed immediately after the procedure in patients treated with enoxaparin only, and 4 h after the procedure in those also treated with eptifibatide.ResultsA peak anti-Xa >0.5 IU/ml was obtained in 97.5% of the population, and 94.6% of patients had their peak anti-Xa level in the predefined target range of 0.5 to 1.5 IU/ml. Advanced age, renal failure, being overweight, and eptifibatide use did not alter the anticoagulation profile. At one-month follow-up, six patients (2.5%) had died, had a myocardial infarction, or undergone an urgent revascularization; all the patients had an anti-Xa level >0.5 IU/ml during PCI. Patients without an ischemic event and without a creatine kinase rise, but with a detectable troponin release in the next 24 h of PCI (>2 μg/ml, n = 21), had similar anti-Xa levels as those without troponin elevation. There were one major and three minor bleeding events that were not associated with anti-Xa overshoot.ConclusionsLow-dose (0.5 mg/kg) IV enoxaparin allows a prespecified target level of anticoagulation (anti-Xa >0.5 IU/ml) in the vast majority of patients undergoing PCI, appears to be safe and effective, allows immediate sheath removal when used alone, and does not require dose adjustment when used with eptifibatide

Eptifibatide provides additional platelet inhibition in Non–ST-Elevation myocardial infarction patients already treated with aspirin and clopidogrel Results of the platelet activity extinction in Non–Q-Wave myocardial infarction with aspirin, clopidogrel, and eptifibatide (PEACE) study

AbstractObjectivesThe present study hypothesis was that eptifibatide offered further antiplatelet efficacy above clopidogrel in non–ST-elevation myocardial infarction (NSTEMI) patients before an expeditive coronary intervention.BackgroundAlthough thienopyridines and glycoprotein (GP) IIb/IIIa antagonists are often co-prescribed in the context of NSTEMI, the antiplatelet interaction of these agents is poorly described and the superiority of GP IIb/IIIa antagonists above thienopyridine treatment alone is not clear.MethodsThirty-two NSTEMI patients treated with aspirin and enoxaparin were studied using flow cytometry to define parameters of platelet activation with a panel of agonists before clopidogrel, after clopidogrel, and during an eptifibatide infusion following the clopidogrel load.ResultsAfter platelet activation with adenosine diphosphate, thrombin receptor-activating peptide, or U46-619, relative reductions in conformationally activated GP IIb/IIIa receptor expression (evaluated with PAC-1) of 48%, 43%, and 33%, respectively (all p < 0.0001), were seen with clopidogrel, but further 80%, 78%, and 72% (all p < 0.0001) reductions were seen with eptifibatide. With the same agonists, fibrinogen binding was significantly reduced after clopidogrel by 70%, 64%, and 81% (all p < 0.0001) and again further reduced with eptifibatide by 90%, 95%, and 69% (all p < 0.0001). The total number of GP IIb/IIIa receptors (measured as P2 expression) and P-selectin expression fell after clopidogrel, after ex vivo stimulation with the same agonists; however, both parameters increased slightly during the eptifibatide infusion.ConclusionsThe activated GP IIb/IIIa expression and fibrinogen binding findings indicate that eptifibatide provides significant potent antiplatelet activity above aspirin and clopidogrel, suggesting additive immediate protection in the treatment of NSTEMI. The P2 and P-selectin findings suggest the possibility of a partial agonist and/or pro-inflammatory effect

Objeto, sujeito, inimigo, vovô: um estudo em etnomuseologia comparada entre os Mebêngôkre-Kayapó e Baniwa do Brasil

International audienceAbstract Ethnomuseology seeks to put indigenous people in dialog with their own material culture heritage. This article reflects on collaborative research carried out with Mebêngôkre-Kayapó and Baniwa consultants on important collections of both groups from the early twentieth century. In addition to noting differences between museological or scientific and indigenous concepts about museum objects, we also noticed a number of cultural differences in the way the two indigenous groups related to objects from their past. While both cultural groups attributed subjective characteristics to museum objects, for the Mebêngôkre-Kayapó this subjectivity expressed itself mostly in terms of possible threats to visitors of the museum collections, leading to a hesitancy to handle museum objects, assumed to be war trophies captured in the past from dangerous enemies. The Baniwa, by contrast, expressed great affection for ‘grandpa’s things’, and they felt they had a right to handle objects that represent the heritage of patrilineal clans. This experience in ethnomuseology highlights the diversity of indigenous concepts, attitudes and expectations about museum collections and the need for the dialogical approach to collaborative research.Resumo A etnomuseologia visa engajar os povos indígenas em um diálogo com a sua cultura material. Este artigo reflete sobre uma experiência efetuada no acervo etnográfico do Museu Paraense Emílio Goeldi com interlocutores Mebêngôkre-Kayapó e Baniwa sobre importantes coleções de seus respectivos povos, as quais datam do início do século XX. Além de perceber diferenças entre conceitos museológicos, ou científicos, e indígenas sobre as peças e os processos de musealização, também foi possível observar uma série de diferenças culturais entre os Mebêngôkre-Kayapó e os Baniwa no que concerne à maneira de se relacionar com os objetos de seu passado. Ambos os grupos atribuíram características subjetivas aos objetos no acervo, mas, no caso dos Mebêngôkre-Kayapó, a subjetividade das peças antigas representava uma ameaça aos visitantes do acervo, levando a um certo receio em manusear as peças, concebidas com troféus de guerra capturados de inimigos perigosos. Os Baniwa, ao contrário, expressavam grande carinho com os ‘objetos do vovô’ e sentiam-se no direito de manusear as peças que representam o patrimônio de clãs patrilineais. Esta experiência em etnomuseologia comparada ressalta a diversidade de conceitos, atitudes e expectativas dos povos indígenas perante às coleções museológicas, e a necessidade desta nova abordagem de pesquisa colaborativa