Evaluating current practice and outcomes of therapeutic anticoagulation during intra-aortic balloon counterpulsation in a coronary care unit

Abstract

Introduction: Therapeutic anticoagulation for intra-aortic balloon pumps (IABPs) in coronary care unit patients is common, and a strategy of selective anticoagulation may minimize bleeding and prevent thrombosis. objective: The present retrospective chart review aimed to determine the proportion of patients with an IABP in place for ≥12 h during coronary care unit admission at a university-affiliated tertiary care centre from January 1, 2007 to December 31, 2011 who were eligible for selective anticoagulation, and to determine the incidence of major bleeding and ischemic complications in this population. Methods: Data collection was performed by one researcher using a standardized form according to prespecified definitions. Data regarding patient characteristics, major bleeds, ischemic events and death were collected while the IABP was in situ and for 24 h after IABP removal. Descriptive statistical analysis was performed. Results : Of the 70 patients included, 50% required an IABP for cardiogenic shock. With respect to medications, 93% were anticoagulated and 67% received ≥3 medications that could increase bleed risk. Eighty percent of patients with IABPs had at least one indication for anticoagulation while the IABP was in situ. The incidence of major bleeds and limb ischemia was 31% and 4%, respectively. Twenty percent of patients died and 93% of these experienced a major bleed. Conclusions: Most patients with IABP have an indication for anticoagulation. The incidence of limb ischemia is relatively low. Given the high incidence of major bleeding, further consideration should be given to the use of anticoagulation and risk factors for bleeding in this patient population.