RANDOMIZED PROSPECTIVE EVALUATION OF PROLONGED VERSUS ABBREVIATED INTRAVENOUS HEPARIN-THERAPY AFTER CORONARY ANGIOPLASTY

Objectives. This study was designed to prospectively evaluate the rout ine use of continuous heparin therapy after successful uncomplicated c oronary angioplasty. Background. The use of such therapy varies among institutions and may increase the incidence of complications. Evaluati on of the risks and benefits of abbreviated heparin therapy combined w ith early sheath removal after coronary angioplasty is necessary to de termine optimal postprocedure care. Methods. We prospectively studied 284 patients who were scheduled for elective coronary angioplasty. His torical, clinical, physiologic and angiographic data were gathered. Al l patients received an initial bolus of heparin and then were randomiz ed during the procedure to receive either no additional heparin therap y or an adjusted 24 h infusion. On the basis of specific criteria, add itional heparin was not withheld if procedural results suggested an in creased risk for complications. Results. Two hundred thirty-eight pati ents completed the study; 46 others were excluded in the catheterizati on laboratory because of unfavorable procedural results. The patients with abbreviated (n = 118) and 24-h (n = 120) therapy did not differ w ith respect to demographic and angiographic findings. However, the for mer had fewer bleeding complications (0% vs. 7%, p < 0.001) and were d ischarged earlier (mean +/- SD 23 +/- 11 h vs. 42 +/- 24 h, p < 0.001) . One patient in this group had a major complication shortly after ang ioplasty. The mean savings in hospital charges in the abbreviated ther apy group was $1,370 ($6,093 +/- $1,772 vs. $7,463 +/- $1,782, p < 0.0 01). Conclusions. Omission of routine heparin therapy after successful coronary angioplasty reduces bleeding complications without increasin g patient risk. Earlier discharge and significant cost savings are pos sible under proper conditions.