Minimal heparinization in coronary angioplasty - How much heparin is really warranted?

The purpose of the study was to assess the results of percutaneous translum inal 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 i n 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 vp by structured telephone questionnaire s at 1 and 6 months after PTCA. Mean activated clotting time obtained 5 min utes after heparin administration was 185 +/- 19 seconds (range 157 to 238) . There were 3 (1%) in-hospital major adverse cardiovascular events: 2 deat hs (0.66%), 1 (0.33%) Q-wave myocardial infarction. Emergency coronary surg ery and stroke were not reported. Six patients (2%) experienced abrupt coro nary occlusion within 14 days after PTCA, warranting repeat target vessel r evascularization. Angiographic and clinical success were achieved in 96% an d 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 o f 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 n eed to confirm this notion. (C) 2000 by Excerpta Medica, Inc.