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We hypothesized that primary percutaneous coronary intervention (PCI) could be performed with prehospital injections of enoxaparin for ST segment elevation myocardial infarction (STEMI). Enoxaparin has been studied in combination with fibrinolysis in STEMI, but has not been evaluated as anticoagulant regimen for primary PCI. In a prospective registry, 143 consecutive patients with STEMI received prehospital 0.5 mg/kg intravenous (i.v.) bolus followed by 1 mg/kg subcutaneous enoxaparin before immediate transport for PCI. We focused on anti-Xa activities before and after PCI, bleedings, infarct-related artery patency, and major adverse cardiac events at day 30. Anti-Xa activity was at the target level (>0.5 IU/ml) in 99% of patients during PCI, and in 100% 4 hr after injections; over-anticoagulation (>1.5 IU/ml) was noted in 9 and 2%, respectively at start and 4 hr after injections. Bleeding complications with enoxaparin were rare: major in 1.4% (no intracranial hemorrhages), minor in 2.1%. A patent infarct-related artery (TIMI 2 + 3) was observed in 40.6% of the patients before PCI. TIMI 3 flow was obtained in 88.1% of the cases after PCI. Major adverse cardiac events at 30 days occurred in 5.6% of cases: death 2.8%, reinfarction 3.5%, and target lesion revascularisation 3.5%. Prehospital i.v. and subcutaneous enoxaparin provides simple and rapid anticoagulation for PCI in STEMI patients. Enoxaparin dose needs to be reduced regarding the 9% of over-anticoagulation. This study suggests the potential of enoxaparin as an alternative anticoagulant regimen for primary PCI.

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This Article deals with the issues related to the judicial review of transnational acts which are adopted particularly within the context of the European integration process. The European Union is a privileged playground for the development of administrative acts of this type, primarily because of the existence of various and diverse administrative cooperation mechanisms. Transnational administrative acts are, either because of their adoption process or because of their conditions of enforcement, governed by at least two national legal orders. The question of the availability of judicial review in the context of transnational administrative acts is a complex one, because the presence of one exogeneous element may disrupt the straightforward path toward the right of access to courts—as both the determination of the competent court and the scope of the review carried out by the court seized become uncertain. This Article first draws up a typology of transnational administrative acts. Second, on the basis of this typology, this Article analyzes the solutions developed by the case law of the Court of Justice and assesses them in the light of the principles of territoriality of administrative law and the right to effective judicial protection.

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