Heparin Reversal for Coronary Artery Perforation

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.