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Published on: July 31, 2016
Heparin Reversal for Coronary Artery Perforation
Yuichi Sawayama1,2, Kenta Sasaki1, Narumi Taninobu1
1Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
Insights
Reversing heparin during percutaneous coronary intervention (PCI) for coronary artery perforation (CAP) aids hemostasis but risks thrombosis if a device remains. Heparin reversal improved hemostasis but increased thrombosis risk when activated clotting time was low.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
- Cardiovascular Surgery
Background:
- Coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) is a serious complication.
- Heparin reversal is used for hemostasis but carries a risk of thrombosis, especially with indwelling devices.
Purpose of the Study:
- To evaluate the impact of heparin reversal on outcomes in patients with CAP and an intracoronary device in place.
- To assess the safety and efficacy of heparin reversal in this specific clinical scenario.
Main Methods:
- Retrospective analysis of CAP cases during PCI (January 2006 - October 2023).
- Patients were stratified based on whether heparin reversal was performed with an intracoronary device in situ.
- Outcomes included coronary thrombosis, successful hemostasis, and all-cause mortality.
Main Results:
- CAP occurred in 1.6% of PCI cases.
- Heparin reversal with a device in place was performed in 57% of CAP patients.
- Coronary thrombosis occurred in 7.6% of those with heparin reversal and a device.
- Low activated clotting time (ACT < 150 seconds) correlated with thrombosis.
- Heparin reversal was associated with successful hemostasis (91% vs. 73%) but not mortality.
Conclusions:
- Heparin reversal in CAP patients with an indwelling device increases coronary thrombosis risk, particularly with ACT < 150 seconds.
- While not significantly impacting mortality, heparin reversal improves hemostasis rates.
Background:
Reversing heparin when managing coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) can provide hemostasis but may cause coronary thrombosis if a device is still present in a coronary artery.
Aims:
To assess the impact of heparin reversal while an intracoronary artery device is in place for CAP.
Methods:
This study analyzed CAP cases during PCI from January 2006 to October 2023. Patients were grouped according to implementing heparin reversal while an intracoronary artery device was in place. The safety outcome was coronary thrombosis after CAP. The efficacy outcomes were successful hemostasis and death from any cause.
Results:
CAP occurred in 368 of 22,368 cases (1.6%). Patients who had heparin reversal with a device in place comprised 211 (57%). Among these, coronary thrombosis occurred in 16 (7.6%). An activated clotting time (ACT) 〈150 seconds was significantly correlated with coronary thrombosis. Heparin reversal with a device in place was significantly associated with successful hemostasis (heparin reversal 91% vs. no heparin reversal 73%; adjusted odds ratio 2.78; 95% confidence interval 1.27-6.13; p = 0.011), but was not different for death from any cause (heparin reversal 4.3% vs. no heparin reversal 5.7%; adjusted odds ratio 0.97; 95% confidence interval 0.28-3.43; p = 0.964).
Conclusion:
Heparin reversal with a device in place was associated with an increased risk of coronary thrombosis when ACT was less than 150 seconds. While it may not have a substantial association with a reduced risk of mortality, it offers an advantage in achieving successful hemostasis.
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