Abstract
A large variety exists for many aspects of the use of heparin as periprocedural prophylactic antithrombotics (PPAT) during peripheral arterial interventions (PAI). This variation is present, not only within countries, but also between them. Due to a lack of (robust) data, no systematic review on the use of heparin during PAI could be justified. A synopsis of all available literature on heparin during PAI describes that heparin is used on technical equipment to reduce the thrombogenicity and in the flushing solution with saline. Heparin could have a cumulative anticoagulant effect when used in combination with ionic contrast medium. No level-1 evidence exists on the use of heparin. A measurement of actual anticoagulation status by means of an activated clotting time should be mandatory.
Highlights
Recent extensive surveys amongst interventional radiologists (IR) have shown that heparin is used by almost all European IR during peripheral arterial interventions (PAI) [1, 2]
Heparin is used as a periprocedural prophylactic antithrombotic (PPAT) agent to prevent distal and proximal arterial thromboembolic complications (ATEC) and to reduce the formation of thrombus on catheters and to prevent the formation of blood clots within catheters
This study showed an increased risk for bleeding complications in the heparin group at the access site (OR = 5.7; 95% CI = 1.3–25) without a reduction of arterial thromboembolic complications in the heparin group
Summary
Recent extensive surveys amongst interventional radiologists (IR) have shown that (unfractionated) heparin is used by almost all European IR during peripheral arterial interventions (PAI) [1, 2]. Surveys from the United Kingdom (UK) and Netherlands showed that only a small minority of IR implemented such a pointof-care measurement in daily routine [1, 2] This policy of not performing a measurement of the actual heparin-effect adds to the risk of thromboembolic complications, due to insufficient dosing of heparin and of bleeding complications, due to “over-dosing” of heparin, during PAI. For the purpose of creating such guidelines, a study group was formed in Netherlands This group was instituted in close collaboration between the Dutch Society of Vascular Surgery and the Dutch Society of Interventional Radiology (NGIR) and was named CAPPA: Consensus on Arterial Periprocedural Anticoagulation [2, 14,15,16].
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