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Heparins crossover in percutaneous coronary interventions: a real issue with increasing rate of transradial
Alessandro Sciahbasi1, Stefano Rigattieri, Simone Calcagno
1aDepartment of Interventional Cardiology, Sandro Pertini Hospital, ASL RMB bDepartment of Cardiology, University La Sapienza cEmergency Department, Sandro Pertini Hospital, ASL RMB, Rome, Italy.
Insights
Switching from enoxaparin to unfractionated heparin (UFH) during percutaneous coronary interventions (PCIs) did not increase bleeding complications. This retrospective study found no significant difference in bleeding risk between heparin crossover and UFH alone groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Current guidelines recommend against intraprocedural unfractionated heparin (UFH) use in patients pretreated with enoxaparin.
- Percutaneous coronary interventions (PCIs) often require careful management of anticoagulation.
- The safety of switching anticoagulant agents during PCI is a critical clinical question.
Purpose of the Study:
- To evaluate bleeding complications associated with intraprocedural heparin crossover therapy in patients undergoing PCI.
- To compare bleeding risks between patients switching from enoxaparin to UFH versus those receiving UFH alone during PCI.
Main Methods:
- Retrospective analysis of PCI procedures performed between January 2011 and December 2013 at two Italian hospitals.
- Propensity-matched analysis created two groups: Group 1 (enoxaparin to UFH crossover) and Group 2 (UFH alone).
- Primary endpoint: hemoglobin drop of at least 3 g/dL within 48 hours post-PCI.
Main Results:
- 309 patients were included after propensity matching (104 in Group 1, 205 in Group 2).
- No significant difference in the primary endpoint (hemoglobin drop) between groups (2.9% vs. 3.4%, P=0.550).
- Major adverse cardio-cerebrovascular events also did not differ significantly between the groups (1.9% vs. 3.9%, P=0.50).
Conclusions:
- Intraprocedural heparin crossover from enoxaparin to UFH during PCI is not associated with an increased bleeding risk.
- Findings suggest that current guideline recommendations may need re-evaluation.
- This retrospective study supports the safety of heparin crossover in specific PCI scenarios.
Aims:
Current guidelines give a class III recommendation to the intraprocedural use of unfractionated heparin (UFH) in patients pretreated with enoxaparin. The aim of our study was to evaluate bleeding complications in patients who underwent percutaneous coronary interventions (PCIs) performed using intraprocedural crossover of heparin therapy.
Methods:
We retrospectively evaluated all PCIs performed at two Italian hospitals since January 2011 to December 2013. After a propensity-matched analysis, patients were divided into two groups (with a ratio 1 : 2) according to intraprocedural crossover of heparins (from enoxaparin to UFH) (Group 1) or intraprocedural UFH alone (Group 2). The primary end-point was a haemoglobin drop of at least 3 g/dl within 48 h after the procedure.
Results:
During the 3 years analysed, 3224 patients underwent PCI, and after the propensity analysis, 309 patients were considered eligible for our study: 104 patients in Group 1 (69 ± 12 years, 78% men) and 205 patients in Group 2 (69 ± 13 years, 80% men, P = NS). There were no significant differences between the two groups for BMI, periprocedural use of antiplatelet therapy, baseline haemoglobin haematocrit or platelets levels. The primary end-point did not differ between the two groups (2.9% in Group 1 and 3.4% in Group 2, P = 0.550). Also, nadir of haematocrit or haemoglobin levels did not differ between the two groups. Finally, in hospital, major adverse cardio-cerebrovascular events did not differ between the two groups (1.9% in Group 1 and 3.9% in Group 2, P = 0.50).
Conclusion:
In this retrospective analysis of a large PCI database, the 'heparins crossover' during PCI was not associated with increased bleeding risk.
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