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Systemic heparinization during percutaneous coronary angiography: evaluation of effectiveness in decreasing
Insights
Systemic heparinization significantly reduces thrombotic and embolic complications during coronary angiography. This preventive measure is safe and effective, minimizing risks like reduced blood flow and pulse loss in patients undergoing arterial catheterization.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Arterial catheterization, particularly for coronary angiography, carries risks of thrombotic and embolic complications.
- Systemic heparinization is a proposed prophylactic strategy to mitigate these risks.
Purpose of the Study:
- To evaluate the efficacy of systemic heparinization in preventing thrombotic and embolic complications following percutaneous femoral arterial coronary angiography.
- To assess the safety and impact of heparinization on limb perfusion and clinical outcomes.
Main Methods:
- A randomized controlled trial involving 95 patients undergoing percutaneous coronary angiography.
- Patients were assigned to either a heparinized or non-heparinized group.
- Clinical assessment and electrical impedance flow measurements were used to monitor for complications and blood flow at multiple time points.
Main Results:
- The non-heparinized group experienced a 11% incidence of lost distal leg pulses, with two requiring embolectomy.
- No pulse loss was observed in the heparinized group.
- Reduced blood flow was significantly more prevalent in the catheterized limb of non-heparinized patients compared to the heparinized group at all post-catheterization time points.
Conclusions:
- Systemic heparinization is a safe and effective adjunct for reducing thromboembolic complications associated with percutaneous coronary angiography.
- Heparinization demonstrably improves limb perfusion and prevents clinically significant embolic events.
Abstract:
Systemic heparinization has been advocated as preventive for thrombotic and embolic complications of arterial catheterization. To test this hypothesis, 95 patients undergoing coronary angiography via the percutaneous femoral arterial approach were randomized into heparinized and nonheparinized groups. Evaluation for thrombotic and embolic complications by clinical means and non-invasive electrical impedance flow measurements in the lower limbs was performed precatheterization, postcatherization, and at 4 and 24 hr. Clinical data reveal loss of distal leg pulses in 11% (5/74) of the nonheparinized group, with two of these individuals developing signs of claudication and requiring embolectomy. No individuals (0/48) in the heparinized group lost distal leg pulses. Immediate, 4-hr, and 24-hr post-catheterization bloodflow was 12%, 10%, and 12% lower, respectively, in the catheterized limb of those in the nonheparinized group. At 24 hr 52% of the nonheparinized group had bloodflow levels lower than the precatheterization levels in the right (catheterized) extremity, while 2% (2/48) of the heparinized group had a similar reduction. One possible complication of excess bleeding was noted with heparin. It is concluded that systemic heparinization is safe and can be an important adjunct in the reduction of thromboembolic complications of percutaneous coronary angiography.