BACKGROUND: Anticoagulation with heparin is recommended with intra-aortic balloon pump (IABP) to prevent thrombosis and embolization. However, anticoagulation increases the risk of bleeding, particularly in combination with glycoprotein (GP) IIb/IIIa antagonists. HYPOTHESIS: We investigated the safety of using GP IIb/IIIa antagonists without heparin after IABP insertion in patients who underwent primary percutaneous coronary intervention (PCI). METHODS: Consecutive patients with acute myocardial infarction (AMI), who underwent primary PCI and were treated with GP IIb/IIIa antagonists without concomitant heparin, and in whom IABP was inserted, were followed during hospitalization for thrombotic and hemorrhagic complications. RESULTS: Ninety-seven patients were included in this analysis. Glycoprotein IIb/IIIa antagonist treatment duration was 12-24 h in 89% of patients, and IABP duration was up to 48 h in 97% of patients. Three patients (3.1%) developed vascular complications: 1 had a major limb ischemia (long IABP treatment), 1 had a minor limb ischemia, and 1 had a cerebrovascular event (after prolonged resuscitation). All patients were already on heparin at the time of the thrombotic events. The rates of major and minor bleeding complications were 9% and 15.5%, respectively. CONCLUSIONS: The rate of thrombotic complications is relatively low in post-primary PCI patients with IABP treated with GP IIb/IIIa antagonists without concomitant heparin therapy. Such an approach may reduce the risk of hemorrhagic complications, with low risk of thrombotic complications.
BACKGROUND: Anticoagulation with heparin is recommended with intra-aortic balloon pump (IABP) to prevent thrombosis and embolization. However, anticoagulation increases the risk of bleeding, particularly in combination with glycoprotein (GP) IIb/IIIa antagonists. HYPOTHESIS: We investigated the safety of using GP IIb/IIIa antagonists without heparin after IABP insertion in patients who underwent primary percutaneous coronary intervention (PCI). METHODS: Consecutive patients with acute myocardial infarction (AMI), who underwent primary PCI and were treated with GP IIb/IIIa antagonists without concomitant heparin, and in whom IABP was inserted, were followed during hospitalization for thrombotic and hemorrhagic complications. RESULTS: Ninety-seven patients were included in this analysis. Glycoprotein IIb/IIIa antagonist treatment duration was 12-24 h in 89% of patients, and IABP duration was up to 48 h in 97% of patients. Three patients (3.1%) developed vascular complications: 1 had a major limb ischemia (long IABP treatment), 1 had a minor limb ischemia, and 1 had a cerebrovascular event (after prolonged resuscitation). All patients were already on heparin at the time of the thrombotic events. The rates of major and minor bleeding complications were 9% and 15.5%, respectively. CONCLUSIONS: The rate of thrombotic complications is relatively low in post-primary PCI patients with IABP treated with GP IIb/IIIa antagonists without concomitant heparin therapy. Such an approach may reduce the risk of hemorrhagic complications, with low risk of thrombotic complications.
Authors: M Meco; G Gramegna; A Yassini; A Bellisario; E Mazzaro; M Babbini; A Pediglieri; P Panisi; G Tarelli; A Frigiola; L Menicanti; S Cirri Journal: J Cardiovasc Surg (Torino) Date: 2002-02 Impact factor: 1.888
Authors: J J Ferguson; M Cohen; R J Freedman; G W Stone; M F Miller; D L Joseph; E M Ohman Journal: J Am Coll Cardiol Date: 2001-11-01 Impact factor: 24.094
Authors: Gregg W Stone; E Magnus Ohman; Michael F Miller; Debra L Joseph; Jan T Christenson; Marc Cohen; Philip M Urban; Ramachandra C Reddy; Robert J Freedman; Karen L Staman; James J Ferguson Journal: J Am Coll Cardiol Date: 2003-06-04 Impact factor: 24.094
Authors: Frederick A Spencer; Joel M Gore; Jorge Yarzebski; Darleen Lessard; Elizabeth A Jackson; Robert J Goldberg Journal: Am J Cardiol Date: 2003-08-15 Impact factor: 2.778