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Prolonged heparin after uncomplicated coronary interventions: a prospective, randomized trial
A R Garachemani1, U Kaufmann, M Fleisch
1Department of Cardiology, University Hospital, Bern, Switzerland.
Insights
Omitting continuous heparin infusion after successful percutaneous transluminal coronary angioplasty (PTCA) does not increase cardiac complications. This practice allows for earlier patient discharge and reduced costs, suggesting routine heparin use may be unnecessary.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Continuous heparin infusion post-percutaneous transluminal coronary angioplasty (PTCA) is associated with prolonged hospital stays and increased bleeding risk.
- Uncomplicated coronary interventions, including stent implantation, necessitate evaluating heparin's role.
Purpose of the Study:
- To assess if omitting post-procedure heparin infusion after successful PTCA increases acute cardiac complications.
- To evaluate the safety and efficacy of heparin omission in patients with stable and unstable angina.
Main Methods:
- A randomized trial involving 191 patients undergoing successful PTCA.
- Patients were assigned to either prolonged heparin infusion or no postprocedure heparin.
- Stent usage was recorded, and cardiac and peripheral vascular complications were monitored.
Main Results:
- No significant increase in acute cardiac complications was observed in the heparin omission group (4% vs 4% myocardial infarction).
- Peripheral vascular complications were slightly higher in the heparin group (3% vs 1%).
- No repeat revascularization was needed during hospitalization in either group.
Conclusions:
- Omission of heparin after successful PTCA, with or without stenting, is safe for patients with stable and unstable angina.
- Early sheath removal, shorter hospital stays, and cost savings are benefits of heparin omission.
- Evidence suggests routine post-procedure heparin use after uncomplicated coronary interventions may not be necessary.
Background:
Continuous heparin infusion after percutaneous transluminal coronary angioplasty (PTCA) procedures prolongs the hospital stay and could increase the occurrence of bleeding complications. The aim of this randomized trial was to evaluate whether omission of heparin infusion after uncomplicated coronary interventions in patients with stable and unstable angina with or without stent implantation increased the incidence of acute cardiac complications.
Methods And Results:
A total of 191 consecutive patients who underwent successful PTCA were randomly assigned to receive either prolonged heparin (heparin group) or no postprocedure heparin (control group). The 2 treatment groups were comparable with respect to clinical and angiographic characteristics. Stents were used in 36% of the control group and in 33% of the heparin group. Cardiac complications occurred in 8 (4%) patients. Four (4%) patients in the control group and 3 (3%) patients in the heparin group had a myocardial infarction. One patient in the control group died 3 days after the intervention. No patient in either group needed a repeat revascularization during the target hospitalization. Peripheral vascular complications in the control and heparin groups occurred in 1% and 3% of the patients, respectively.
Conclusions:
Omission of heparin after successful PTCA with or without stent implantation in patients with stable and unstable angina did not significantly increase the incidence of acute cardiac complications. It allows for early sheath removal and patient discharge and saves costs. This study, combined with other small studies in the field, provides strong evidence that heparin should not be used routinely.