Has the required heparin dose increased in PCI? A single-centre experience

Unfractionated heparin (UFH) is routinely used in percutaneous coronary intervention (PCI). The aim of this study was to determine whether the required dose of heparin used during PCI procedures has increased over time, which was our subjective observation. This retrospective study analysed the required heparin dosage in 100 consecutive patients undergoing isolated PCI for each year between 2016 and 2024, starting from 1 January of each year. The primary analysis compared the total heparin dose administered (a) unadjusted and (b) adjusted for weight and procedure duration, between annual populations. A secondary analysis compared heparin dosage in patients with at least one activated clotting time (ACT) value >250 seconds, the target ACT level at our centre. The median total heparin dose rose from 9,000 units (U) in 2016 (interquartile range [IQR] 7,000-11,000 U), to 12,000 U (IQR 10,000-15,000 U) in 2024 (p<0.001). The median weight- and time-adjusted total heparin dose in 2016 was 1.95 (IQR 1.44-2.77) U/kg/min compared with 2.93 (IQR 2.1-3.8) U/kg/min in 2024 (p<0.001). In the secondary analysis (in those who achieved a target ACT >250 seconds), the median dose was 1.81 (IQR 1.21-2.24) U/kg/min in 2016 versus 2.59 (IQR 2.03-3.22) U/kg/min in 2024 (p<0.001). In conclusion, there has been a significant and unexplained increase in the total administered heparin dose for PCI cases in this centre between 2016 and 2024.