Minimal heparinization in coronary angioplasty—how much heparin is really warranted?

• Published in: The American journal of cardiology 2000-04, Vol.85 (8), p.953-956
• Main Authors: Kaluski, Edo, Krakover, Ricardo, Cotter, Gad, Hendler, Alberto, Zyssman, Itzhak, Milovanov, Olga, Blatt, Alex, Zimmerman, Ester, Goldstein, Edna, Nahman, Vera, Vered, Zvi
• Format: Article
• Language: English
• Subjects: Angioplasty; Angioplasty, Balloon, Coronary; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Biological and medical sciences; Cardiovascular disease; Clinical trials; Cohort Studies; Coronary Angiography; Coronary Disease - blood; Coronary Disease - diagnostic imaging; Coronary Disease - therapy; Diseases of the cardiovascular system; Female; Follow-Up Studies; Heparin - administration & dosage; Heparin - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Pharmacology; Pilot Projects; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Safety; Time Factors; Whole Blood Coagulation Time
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(99)00908-X

The purpose of the study was to assess the results of percutaneous transluminal coronary angioplasty (PTCA), performed with a single intravenous bolus of 2,500 U of heparin, in a nonemergency PTCA cohort. Three hundred of 341 consecutive patients (87.9%) undergoing PTCA were prospectively enrolled in the study. They received heparin, 2,500-U intravenous bolus, before PTCA, with intention of no additional heparin administration. Patient and lesion characteristics as well as PTCA results were evaluated independently by 2 physicians. Patients were followed up by structured telephone questionnaires at 1 and 6 months after PTCA. Mean activated clotting time obtained 5 minutes after heparin administration was 185 ± 19 seconds (range 157 to 238). There were 3 (1%) in-hospital major adverse cardiovascular events: 2 deaths (0.66%), 1 (0.33%) Q-wave myocardial infarction. Emergency coronary surgery and stroke were not reported. Six patients (2%) experienced abrupt coronary occlusion within 14 days after PTCA, warranting repeat target vessel revascularization. Angiographic and clinical success were achieved in 96% and 93.3%, respectively. No bleeding or vascular complications were recorded. Six-month follow-up (184 patients) revealed 3 cardiac deaths (1 arrhythmic, 2 after cardiac surgery), 1 Q-wave myocardial infarction, and 9.7% repeat target vessel revascularization. This study suggests that very low doses of heparin and reduced activated clotting time target values are safe in non-emergency PTCA, and can reduce bleeding complications, hospital stay, and costs. Larger, randomized, double-blind heparin dose optimization studies need to confirm this notion.