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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Administration of low molecular weight and unfractionated heparin during percutaneous coronary intervention

Sadegh Ali-Hassan-Sayegh1, Seyed Jalil Mirhosseini1, Azadeh Shahidzadeh1

  • 1Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Indian Heart Journal
|May 3, 2016
PubMed

Insights

Low molecular weight heparin (LMWH) is more effective and safer than unfractionated heparin (UFH) for patients undergoing percutaneous coronary intervention (PCI). LMWH improves myocardial perfusion and reduces re-infarction, bleeding, and mortality rates.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Percutaneous coronary intervention (PCI) is a common procedure for managing coronary artery disease.
  • Heparin anticoagulation is crucial during PCI, with unfractionated heparin (UFH) and low molecular weight heparin (LMWH) being the primary agents.
  • Comparative efficacy and safety data between UFH and LMWH in PCI settings require ongoing evaluation.

Purpose of the Study:

  • To systematically review and meta-analyze the efficacy and safety of UFH versus LMWH in patients undergoing PCI.
  • To assess the impact of LMWH and UFH on key clinical outcomes, including myocardial perfusion, re-infarction, stroke, bleeding, and mortality.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials.
  • Literature search across major databases (Medline, Embase, Elsevier, Web of Knowledge) and Google Scholar.
  • Inclusion of 23 trials with 43,912 patients comparing UFH and LMWH in PCI.

Main Results:

  • LMWH significantly increased thrombolysis in myocardial infarction grade 3 flow compared to UFH (p<0.001).
  • LMWH demonstrated significantly lower rates of re-myocardial infarction (p<0.001), major bleeding (p=0.02), and mortality (p<0.001).
  • No significant differences were observed in target vessel revascularization (p=0.6) or stroke incidence (p=0.7).

Conclusions:

  • LMWH is a preferred anticoagulant over UFH for patients with myocardial infarction undergoing PCI.
  • LMWH offers superior efficacy, evidenced by improved myocardial perfusion and reduced re-infarction.
  • LMWH is associated with a better safety profile, including decreased major bleeding and mortality.

Keywords:
Low molecular weight heparinMyocardial infarctionOutcomePercutaneous coronary interventionUnfractionated heparin

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