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Post-cardiac catheterization access site complications and low-molecular -weight heparin following cardiac
Lee A MacDonald1, Sheridan Meyers, Charles L Bennett
1Division of Cardiology, Department of Meidcine, Northwestern Memorial Hospital Medical School, Chicago, IL 60611, USA. cdavidso@nmh.org
Insights
Low molecular weight heparin enoxaparin use in patients undergoing cardiac procedures can lead to severe, late-onset femoral arterial complications. These risks include pseudoaneurysm and significant bleeding, necessitating careful monitoring post-procedure.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Surgery
Background:
- Low molecular weight heparin (enoxaparin) is frequently used for anticoagulation bridging during temporary warfarin discontinuation for invasive procedures.
- Patients undergoing cardiac catheterization or interventional procedures often require anticoagulation management.
Purpose of the Study:
- To evaluate the clinical outcomes of patients receiving enoxaparin after cardiac catheterization or coronary artery interventional procedures.
- To identify the incidence and nature of severe late enoxaparin-associated hemorrhagic or vascular complications at the femoral arterial puncture site.
Main Methods:
- Retrospective evaluation of 119 patients treated with enoxaparin who underwent cardiac catheterization or coronary artery interventional procedures.
- Analysis of complications occurring between 3 and 11 days post-procedure, focusing on hemorrhagic and vascular events at the femoral access site.
Main Results:
- Five patients (4.2%) experienced severe late enoxaparin-associated complications.
- Complications included femoral arterial pseudoaneurysm (3 patients), hypotension (2 patients), significant hemoglobin decrease (4 patients), and cardiac arrest (1 patient).
- These events occurred between 3 and 11 days post-procedure in patients requiring anticoagulation for conditions like chronic atrial fibrillation or ventricular thrombi.
Conclusions:
- Standard dose enoxaparin administration after percutaneous invasive cardiac procedures carries a risk of delayed, severe hemorrhagic and vascular complications at the access site.
- Close monitoring for these potential complications is crucial in patients receiving enoxaparin for anticoagulation bridging.
Abstract:
The low molecular weight heparin enoxaparin is often administered to patients on long-term anticoagulation regimens who temporarily discontinue warfarin prior to undergoing invasive procedures. The clinical outcome of all enoxaparin-treated patients who underwent cardiac catheterization or coronary artery interventional procedures (n = 119) was evaluated. A total of 5 patients (4.2%) requiring anticoagulation (3 with chronic atrial fibrillation and 2 with ventricular thrombi) developed severe late enoxaparin-associated hemorrhagic or vascular complications at the femoral arterial puncture site between 3 and 11 days post-procedure. Complications included development of femoral arterial pseudoaneurysm (n = 3), hypotension (systolic blood pressure < 90 mmHg) (n = 2), acute decrease in hemoglobin levels to < 8.5 mg/dl (n = 4) and cardiac arrest (n = 1). In patients receiving standard dose enoxaparin after percutaneous invasive cardiac procedures, there is the potential for delayed and severe access site hemorrhagic and vascular complications.