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Low-dose heparin for elective percutaneous coronary intervention
Michael S Lee1, Jared Oyama, Zahid Iqbal
1UCLA Medical Center, Los Angeles, California.
Insights
Low-dose heparin (40 IU/kg) combined with dual antiplatelet therapy is safe and effective for elective percutaneous coronary intervention (PCI), demonstrating a low bleeding risk and suppression of ischemic events.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Current guidelines recommend higher heparin doses (70-100 IU/kg) for elective percutaneous coronary intervention (PCI), potentially increasing bleeding risk.
- Low-dose heparin (40 IU/kg) has not been extensively studied for elective PCI safety and efficacy.
Purpose of the Study:
- To evaluate the safety and efficacy of a low-dose heparin regimen (40 IU/kg) during elective transfemoral percutaneous coronary intervention (PCI).
Main Methods:
- A prospective study of 300 patients undergoing elective transfemoral PCI from January 2008 to October 2012.
- Patients received a 40 IU/kg heparin bolus and dual antiplatelet therapy (clopidogrel and aspirin).
- Primary endpoint: composite of cardiac death, myocardial infarction, urgent revascularization, or major bleeding within 30 days.
Main Results:
- The primary endpoint occurred in 2.3% of patients.
- Major bleeding occurred in 0.3%; cardiac death in 0.3%; myocardial infarction in 1.3%.
- No stent thrombosis was observed.
Conclusions:
- Low-dose heparin (40 IU/kg) with dual antiplatelet therapy is safe and effective for elective transfemoral PCI, associated with low bleeding risk.
- This strategy suppressed ischemic events and may offer cost savings.
- Further randomized trials comparing low-dose heparin with bivalirudin are needed to confirm optimal anticoagulation.
Objectives:
We evaluated the safety and efficacy of low-dose heparin (40 IU/kg) for elective percutaneous coronary intervention (PCI).
Background:
Current guidelines recommend a 70-100 IU/kg bolus of heparin for elective PCI, but this dose may be associated with increased bleeding risk. Low-dose heparin may have an advantage in this regard, but has not been well studied.
Methods:
From January 2008 to October 2012, 300 patients underwent elective transfemoral PCI and were treated with an initial bolus of 40 IU/kg of heparin at the UCLA Medical Center. Dual antiplatelet therapy with clopidogrel and aspirin was administered prior to or just after diagnostic coronary angiography. The primary end-point was the composite of cardiac death, myocardial infarction, urgent target vessel revascularization for ischemia, or major bleeding within 30 days after PCI.
Results:
The mean activating clotting time was 233 ± 28 seconds. The primary end-point occurred in 2.3%. The cardiac death rate was 0.3% but was not related to the PCI. The myocardial infarction rate was 1.3%. Urgent target vessel revascularization occurred in 1 patient (0.3%). The major bleeding rate was 0.3%. No stent thrombosis occurred.
Conclusion:
Using a lower dose of heparin with dual antiplatelet therapy is safe and is associated with a low bleeding risk after transfemoral PCI while providing suppression of ischemic events. This may also represent a cost savings compared with other antithrombotic strategies. A randomized clinical trial comparing low-dose heparin with bivalirudin in patients is required to determine the optimal anticoagulation strategy.
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