Prolonged heparin after uncomplicated coronary interventions: a prospective randomized trial

Abstract

Acute ischemic cardiac complications remain a problem in percutaneous transluminal coronary angioplasty (PTCA). The majority of PTCA-related cardiac complications are caused by abrupt vessel closure, which in the majority of cases occurs immediately after the procedure.1,2 Intraprocedural antiplatelet therapy and anticoagulant therapy have been shown to reduce significantly the incidence of ischemic complications occurring during the intervention,3-6 yet it is unclear whether prolonged postprocedural heparin therapy can prevent abrupt vessel closure. Some authors suggest discontinuation of heparin after PTCA,7 whereas in many centers heparin is routinely administered for 12 to 24 hours after the intervention. Prolonged heparin administration increases peripheral vessel complications and prolongs the hospital stay.8 The aim of this study was to evaluate whether discontinuation of heparin after an uncomplicated PTCA increased in-hospital ischemic cardiac complications. Methods Patients with a successful PTCA who had no noncoronary indication for prolonged heparin administration and gave informed consent were randomly assigned into 2 groups. Patients in the first group (heparin group) received continuous heparin infusion of 1000 units/h for 12 to 20 hours. The arterial sheath was removed a few hours after the discontinuation of heparin. The patients were usually discharged the second day after the procedure. In the second group (control group), no heparin was given after the intervention, the sheath was removed 3 to 4 hours after the procedure, and the patients were generally discharged the following day. PTCA procedures were performed by the femoral route according to techniques previously described by using 5F, 6F, or 7F guiding systems. Intraprocedural treatment consisted of oral or intracoronary nitrates, a bolus of 5000 to 20,000 units of heparin, and 250 mg acetylsalicylic acid intravenously for patients who were not already receiving aspirin therapy. Nonionic contrast medium was used in all cases. Sheath removal in both groups was performed with manual or mechanical compression followed by 6 hours of pressure dressing and bed rest. An electrocardiogram (ECG) and creatine kinase (CK) levels were obtained the day after PTCA and in case of prolonged chest pain. In cases of acute prolonged chest pain or new ECG modifications suspicious of abrupt vessel closure, repeat angiography was considered. Primary end points were the occurrence of myocardial From the Department of Cardiology, University Hospital. Submitted Feb. 26, 1997; accepted Feb. 17, 1998. Reprint requests: Bernhard Meier, MD, University Hospital, 3010 Bern, Switzerland. Copyright © 1998 by Mosby, Inc. 0002-8703/98/$5.00 + 0 4/1/90240 Prolonged heparin after uncomplicated coronary interventions: A prospective, randomized trial