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Safety of low dose heparin in elective coronary angioplasty
K T Koch1, J J Piek, R J de Winter
1Department of Cardiology, University of Amsterdam, The Netherlands.
Insights
Low-dose heparin is safe for elective percutaneous transluminal coronary angioplasty (PTCA), demonstrating high procedural success rates. This approach may reduce complications and hospital stays, potentially enabling outpatient procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for treating coronary artery disease.
- Anticoagulation management, particularly the dose of heparin, is critical for procedural success and patient safety during PTCA.
- Optimizing heparin dosage can potentially minimize procedural complications and improve patient outcomes.
Purpose of the Study:
- To assess the safety and efficacy of a low-dose heparin regimen in patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA).
- To evaluate the incidence of procedural complications, including bleeding and abrupt vessel closure, associated with low-dose heparin during PTCA.
- To determine if a low-dose heparin strategy impacts the need for prolonged anticoagulation or repeat interventions.
Main Methods:
- An open, prospective, single-center study involving 1375 consecutive patients undergoing elective PTCA.
- A standard anticoagulation protocol using a 5000 IU heparin bolus was administered.
- Procedural success was defined by achieving <50% residual stenosis without major adverse events within 48 hours, including death, myocardial infarction, or urgent revascularization.
Main Results:
- Procedural success without clinical events was achieved in 90% of patients.
- The overall mortality rate was 0.3%, with myocardial infarction occurring in 3.3% of procedures.
- Puncture site complications occurred in 2.1% of patients, with a lower incidence (1.9%) in the low-dose heparin group compared to prolonged heparinization (4.9%).
Conclusions:
- Elective PTCA can be safely performed using a low dose of heparin, with a low risk of subacute closure.
- Low-dose heparin may lead to a reduced incidence of puncture site complications.
- This anticoagulation strategy has the potential to shorten hospitalizations and facilitate outpatient angioplasty procedures.
Objectives:
To evaluate the safety of a low dose of heparin in consecutive stable patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA).
Design:
Open prospective study in a single centre.
Patients:
1375 consecutive patients had elective PTCA (1952 lesions: type A 11%, B1 34%, B2 36%, and C 19%). There were no angiographic exclusion criteria.
Interventions:
A bolus of 5000 IU heparin was used as the standard anticoagulation regimen during PTCA. The sheaths were removed immediately after successful completion of the procedure. Prolongation of heparin treatment was left to the operator's discretion.
Main Outcome Measures:
Procedural success was defined as < 50% residual stenosis without death from any cause, acute myocardial infarction, urgent coronary bypass surgery, or repeat angioplasty within 48 hours for acute recurrent ischaemia; the need for prolonged heparinisation; and the occurrence of puncture site complications.
Results:
Procedural success without clinical events was achieved in 90% of patients. Mortality was 0.3%; coronary bypass surgery was performed in 1.7% of the procedures. The rate of myocardial infarction was 3.3%; repeat angioplasty within 48 hours was carried out in 0.7% of patients. A total of 89.1% of the patients were treated according to the protocol. Prolonged treatment with heparin was considered necessary in 123 patients (8.9%). Repeat angioplasty for abrupt closure was performed in two patients shortly after sheath removal and in two during prolonged heparinisation. Puncture site complications occurred in 2.1% of patients (low dose heparin 1.9% and prolonged heparinisation 4.9%).
Conclusion:
Elective PTCA can be safely performed using a low dose of heparin, with a negligible risk for subacute closure. Low dose heparin may reduce the incidence of puncture site complications, shorten hospitalisation, and enable out-patient angioplasty.