Heparin after percutaneous intervention (HAPI): A prospective multicenter randomized trial of three heparin regimens after successful coronary intervention

OBJECTIVES The purpose of this study was to determine the incidence of blee ding, vascular, and ischemic complications using three different heparin re gimens after successful intervention. BACKGROUND The ideal dose and duration of heparin infusion after successful coronary intervention is unknown. METHODS Patients were randomized to one of three heparin strategies after c oronary intervention: Group 1 (n = 157 patients) received prolonged (12 to 24 h) heparin infusion followed by sheath removal; Group 2 (n = 120 patient s) underwent early removal of sheaths, followed by reinstitution of heparin infusion for 12 to 18 h; Group 3 (n = 137 patients) did not receive any fu rther heparin after intervention with early sheath removal. The primary end point of the study was the combined incidence of in-hospital bleeding and vascular events. Secondary end points included in-hospital ischemic events, length of stay, cost and one-month outcome. RESULTS After successful coronary intervention, 414 patients were randomize d. Unstable angina or postinfarction angina was present in 83% of patients before intervention. The combined incidence of bleeding and vascular events was 21% in Group 1, 14% in Group 2 and 8% in Group 3 (p = 0.01). The overa ll incidence of in-hospital ischemic complications was 2.2%; there were no differences between groups. Length of hospital stay was shorter (p = 0.033) and adjusted hospital cost was lower (p < 0.001) for Group 3. At 30 days, the incidence of delayed cardiac and vascular events was similar for all th ree groups. CONCLUSIONS Heparin infusion after successful coronary intervention is asso ciated with more minor bleeding and vascular injury, prolonged length of st ay and increased cost. In-hospital and one-month ischemic events rarely occ ur after successful intervention, irrespective of heparin use. Routine post procedure heparin is not recommended, even in patients who present with uns table ischemic syndromes. (C) 1999 by the American College of Cardiology.