SAFETY OF LOW-DOSE HEPARIN IN ELECTIVE CORONARY ANGIOPLASTY

Objectives-To evaluate the safety of a low dose of heparin in consecut ive stable patients undergoing elective percutaneous transluminal coro nary angioplasty (PTCA). Design-Open prospective study in a single cen tre. Patients-1375 consecutive patients had elective PTCA (1952 lesion s: type A 11%, B1 34%, B2 36%, and C 19%). There were no angiographic exclusion criteria. Interventions-A bolus of 5000 IU heparin was used as the standard anticoagulation regimen during PTCA. The sheaths were removed immediately after successful completion of the procedure. Prol ongation of heparin treatment was left to the operator's discretion. M ain outcome measures-Procedural success was defined as <50% residual s tenosis without death from any cause, acute myocardial infarction, urg ent coronary bypass surgery, or repeat angioplasty within 48 hours for acute recurrent ischaemia; the need for prolonged heparinisation; and the occurrence of puncture site complications. Results-Procedural suc cess without clinical events was achieved in 90% of patients. Mortalit y was 0.3%; coronary bypass surgery was performed in 1.7% of the proce dures. The rate of myocardial infarction was 3.3%; repeat angioplasty within 48 hours was carried out in 0.7% of patients. A total of 89.1% of the patients were treated according to the protocol. Prolonged trea tment with heparin was considered necessary in 123 patients (8.9%). Re peat angioplasty for abrupt closure was performed in two patients shor tly after sheath removal and in two during prolonged heparinisation. P uncture site complications occurred in 2.1% of patients low dose hepar in 1.9% and prolonged heparinisation 4.9%). Conclusion-Elective PTCA c an be safely performed using a low dose of heparin, with a negligible risk for subacute closure. Low dose heparin may reduce the incidence o f puncture site complications, shorten hospitalisation, and enable out patient angioplasty.