High dose heparin as pretreatment for primary angioplasty in acute myocardial infarction: The Heparin in Early Patency (HEAP) randomized trial

Objectives. In the Heparin in Early Patency (HEAP) pilot study a beneficial effect of high-dose heparin on early patency in acute myocardial infarctio n (MI) was observed in a matched control study. Background. High dose bolus intravenous injection of heparin may achieve ly sis of coronary thrombi and could enhance early patency of the infarct rela ted vessel in patients with MI scheduled for primary angioplasty. Methods. Before primary angioplasty, 584 patients with MI entered an open r andomized trial of high dose (300 IU/kg) or low dose (0 or 5,000 IU) hepari n. Of the 584 patients, 299 were randomized to high dose and 285 patients t o low dose heparin. Results. Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 was observed before primary angioplasty in 65 patients (22%) in the high dose group and 60 patients (21%) in the low dose heparin group (p > 0.1), wherea s TIMI flow grade 3 was observed in 38 (13%) and 24 patients (9%), respecti vely (p = 0.11). There were no differences in the clinical end points betwe en the two groups. There were no hemorraghic strokes, while 10% of the pati ents in the high dose group required blood transfusion versus 6% in the low dose/no heparin group (p = 0.07). No subsets of patients showed beneficial effects of high dose heparin, such as patients with longer delay between h eparin administration and diagnostic angiogram or patients with short delay between symptom onset and admission. Conclusions. There is no benefit of high dose bolus heparin on early patenc y compared with no or low dose heparin. (C) 2000 by the American College of Cardiology.