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Heparin dosing in patients undergoing coronary intervention
J J Popma1, R Prpic, A J Lansky
1Department of Internal Medicine, the Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
The American Journal of Cardiology
|November 11, 1998
Summary
Unfractionated heparin is crucial for coronary interventions, but optimal dosing and duration are key. Lower doses and shorter use reduce bleeding risks and thrombocytopenia, improving patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Management
Background:
- Unfractionated heparin is a cornerstone in preventing thrombosis during coronary interventions.
- Heparin use is associated with bleeding complications (3.9-16.4%) and potential thrombocytopenia.
- Evolving practices in heparin timing, dosing, and duration aim to optimize efficacy and safety.
Purpose of the Study:
- To review current guidelines and evidence regarding unfractionated heparin use in coronary interventions.
- To discuss the impact of heparin dosing and duration on patient outcomes, including bleeding and thrombocytopenia.
- To provide recommendations for heparin management in conjunction with glycoprotein IIb/IIIa inhibitors.
Main Methods:
- Review of current literature and clinical guidelines on heparin therapy in interventional cardiology.
- Analysis of data on activated clotting time (ACT) targets based on device type (HemoTec, Hemochron).
- Evaluation of weight-adjusted heparin dosing strategies and their impact on anticoagulation levels.
Main Results:
- Recommended ACT targets vary by device: 250-300s (HemoTec) and 300-350s (Hemochron) without GP IIb/IIIa inhibitors.
- Lower weight-adjusted heparin doses (70-100 units/kg) are trending to minimize excessive anticoagulation.
- When GP IIb/IIIa inhibitors are used, heparin doses can be reduced to 70 units/kg for a target ACT of 200s.
- Continued heparin post-intervention offers little benefit and increases bleeding risk.
Conclusions:
- Optimizing unfractionated heparin therapy involves careful consideration of timing, weight-adjusted dosing, and duration.
- Reduced heparin dosing and shorter duration, especially when combined with GP IIb/IIIa inhibitors, are associated with lower complication rates.
- Discontinuation of heparin after uncomplicated coronary intervention is advisable to mitigate bleeding risks.