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Minimal heparinization in coronary angioplasty--how much heparin is really warranted?
E Kaluski1, R Krakover, G Cotter
1Assaf Harofeh Cardiology Institute, Zerifin, Israel. ekaluski@asaf.health.gov.il
Insights
This study shows that a low dose of heparin during percutaneous transluminal coronary angioplasty (PTCA) is safe and effective, reducing complications and costs. Further research is needed to confirm these findings in larger trials.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for treating coronary artery disease.
- Standard heparin protocols during PTCA often involve higher doses, potentially leading to increased bleeding risks and costs.
- Optimizing heparin dosage in non-emergency PTCA could improve patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate the safety and efficacy of a single, low-dose intravenous heparin bolus (2,500 U) in a non-emergency percutaneous transluminal coronary angioplasty (PTCA) cohort.
- To assess major adverse cardiovascular events, procedural success rates, and long-term outcomes with this reduced heparin regimen.
Main Methods:
- Prospective enrollment of 300 patients undergoing non-emergency PTCA.
- Administration of a single 2,500 U intravenous heparin bolus prior to PTCA, with no additional heparin.
- Independent evaluation of patient/lesion characteristics and PTCA results by two physicians.
- Follow-up via structured telephone questionnaires at 1 and 6 months post-procedure.
Main Results:
- Low in-hospital major adverse cardiovascular events (1%): 2 deaths (0.66%), 1 Q-wave myocardial infarction (0.33%).
- High rates of angiographic (96%) and clinical (93.3%) success.
- No reported bleeding or vascular complications.
- Six-month follow-up showed 3 cardiac deaths, 1 Q-wave myocardial infarction, and 9.7% repeat target vessel revascularization.
Conclusions:
- A very low dose of heparin (2,500 U) with reduced activated clotting time targets appears safe and effective for non-emergency PTCA.
- This approach may reduce bleeding complications, hospital stay, and associated costs.
- Larger, randomized, double-blind studies are recommended to confirm these findings and optimize heparin dosing.
Abstract:
The purpose of the study was to assess the results of percutaneous transluminal coronary angioplasty (PTCA), performed with a single intravenous bolus of 2,500 U of heparin, in a nonemergency PTCA cohort. Three hundred of 341 consecutive patients (87.9%) undergoing PTCA were prospectively enrolled in the study. They received heparin, 2,500-U intravenous bolus, before PTCA, with intention of no additional heparin administration. Patient and lesion characteristics as well as PTCA results were evaluated independently by 2 physicians. Patients were followed up by structured telephone questionnaires at 1 and 6 months after PTCA. Mean activated clotting time obtained 5 minutes after heparin administration was 185+/-19 seconds (range 157 to 238). There were 3 (1%) in-hospital major adverse cardiovascular events: 2 deaths (0.66%), 1 (0.33%) Q-wave myocardial infarction. Emergency coronary surgery and stroke were not reported. Six patients (2%) experienced abrupt coronary occlusion within 14 days after PTCA, warranting repeat target vessel revascularization. Angiographic and clinical success were achieved in 96% and 93.3%, respectively. No bleeding or vascular complications were recorded. Six-month follow-up (184 patients) revealed 3 cardiac deaths (1 arrhythmic, 2 after cardiac surgery), 1 Q-wave myocardial infarction, and 9.7% repeat target vessel revascularization. This study suggests that very low doses of heparin and reduced activated clotting time target values are safe in non-emergency PTCA, and can reduce bleeding complications, hospital stay, and costs. Larger, randomized, double-blind heparin dose optimization studies need to confirm this notion.