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Randomized prospective evaluation of prolonged versus abbreviated intravenous heparin therapy after coronary
H Z Friedman1, D R Cragg, S M Glazier
1Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073.
Insights
Discontinuing routine heparin therapy after coronary angioplasty significantly reduces bleeding complications and shortens hospital stays. This approach offers cost savings without increasing patient risk, supporting abbreviated heparin protocols.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Continuous heparin therapy post-coronary angioplasty is institution-dependent.
- Its routine use may increase complication rates.
- Optimal post-procedure care requires evaluating risks/benefits of abbreviated heparin and early sheath removal.
Purpose of the Study:
- To prospectively evaluate the routine use of continuous heparin therapy after successful, uncomplicated coronary angioplasty.
- To assess the safety and efficacy of abbreviated heparin therapy versus 24-hour infusion.
- To determine the impact on bleeding complications, length of stay, and hospital charges.
Main Methods:
- Prospective study of 284 patients undergoing elective coronary angioplasty.
- Randomization to either no additional heparin or a 24-hour adjusted infusion post-procedure.
- Data collection included clinical, physiologic, and angiographic parameters.
Main Results:
- 238 patients completed the study; 46 were excluded due to procedural complications.
- Abbreviated heparin group (118 patients) showed significantly fewer bleeding complications (0% vs. 7%, p < 0.001).
- Abbreviated therapy led to earlier discharge (23 ± 11 h vs. 42 ± 24 h, p < 0.001) and $1,370 cost savings.
Conclusions:
- Omitting routine continuous heparin therapy after successful coronary angioplasty is safe and effective.
- Reduces bleeding complications and length of hospital stay.
- Enables significant cost savings and earlier patient discharge under appropriate conditions.
Objectives:
This study was designed to prospectively evaluate the routine use of continuous heparin therapy after successful uncomplicated coronary angioplasty.
Background:
The use of such therapy varies among institutions and may increase the incidence of complications. Evaluation of the risks and benefits of abbreviated heparin therapy combined with early sheath removal after coronary angioplasty is necessary to determine optimal postprocedure care.
Methods:
We prospectively studied 284 patients who were scheduled for elective coronary angioplasty. Historical, clinical, physiologic and angiographic data were gathered. All patients received an initial bolus of heparin and then were randomized during the procedure to receive either no additional heparin therapy or an adjusted 24-h infusion. On the basis of specific criteria, additional heparin was not withheld if procedural results suggested an increased risk for complications.
Results:
Two hundred thirty-eight patients completed the study; 46 others were excluded in the catheterization laboratory because of unfavorable procedural results. The patients with abbreviated (n = 118) and 24-h (n = 120) therapy did not differ with respect to demographic and angiographic findings. However, the former had fewer bleeding complications (0% vs. 7%, p < 0.001) and were discharged earlier (mean +/- SD 23 +/- 11 h vs. 42 +/- 24 h, p < 0.001). One patient in this group had a major complication shortly after angioplasty. The mean savings in hospital charges in the abbreviated therapy group was $1,370 ($6,093 +/- $1,772 vs. $7,463 +/- $1,782, p < 0.001).
Conclusions:
Omission of routine heparin therapy after successful coronary angioplasty reduces bleeding complications without increasing patient risk. Earlier discharge and significant cost savings are possible under proper conditions.