Mohammad Javad Zibaeenezhad1, Yalda Mazloum. 1. Cardiovascular Research Centre (CRC), Shiraz University of Medical Sciences (SUMS), Shiraz, Iran. zibaeem2@sums.ac.ir
Abstract
OBJECTIVE: The aim of this randomized trial was to evaluate whether omission of heparin infusion after successful coronary interventions increased the incidence of ischaemic complications. Continuous heparin infusion after percutaneous coronary interventions could increase the occurrence of bleeding; however, the probable advantages of prolonged heparin infusion are unknown. METHODS AND RESULTS: A total of 200 consecutive patients who underwent successful PTCA were randomly assigned to receive either prolonged heparin (heparin group) or no post-procedural heparin (control group). The two treatment groups were comparable with respect to clinical and angiographic characteristics. The primary end point of the study was in-hospital bleeding and vascular events and secondary end points included in-hospital ischaemic events. Ischaemic complications occurred in 17 (8.5%) patients; ten patients (10%) in the control group and seven patients (7%) in the heparin group. Chest pain with new ECG changes was seen in 11 (5.5%) patients (4% in the heparin group vs. 7% in the control group). Two patients (2%) in the control group had a Q-wave myocardial infarction and one patient in the control group died as a result of ischaemic complications. In the heparin group 2 (2%) patients developed non-Q-wave myocardial infarction and one patient (1%) underwent emergency CABG during the same hospitalization. The difference between groups regarding secondary end points was not statistically significant (P = 0.44). CONCLUSION:Heparin infusion after successful coronary interventions could increase the occurrence of bleeding and vascular injury; however, omission of heparin after a successful procedure did not significantly increase the incidence of ischaemic complications. Thus routine post-procedure heparin is not recommended.
RCT Entities:
OBJECTIVE: The aim of this randomized trial was to evaluate whether omission of heparin infusion after successful coronary interventions increased the incidence of ischaemic complications. Continuous heparin infusion after percutaneous coronary interventions could increase the occurrence of bleeding; however, the probable advantages of prolonged heparin infusion are unknown. METHODS AND RESULTS: A total of 200 consecutive patients who underwent successful PTCA were randomly assigned to receive either prolonged heparin (heparin group) or no post-procedural heparin (control group). The two treatment groups were comparable with respect to clinical and angiographic characteristics. The primary end point of the study was in-hospital bleeding and vascular events and secondary end points included in-hospital ischaemic events. Ischaemic complications occurred in 17 (8.5%) patients; ten patients (10%) in the control group and seven patients (7%) in the heparin group. Chest pain with new ECG changes was seen in 11 (5.5%) patients (4% in the heparin group vs. 7% in the control group). Two patients (2%) in the control group had a Q-wave myocardial infarction and one patient in the control group died as a result of ischaemic complications. In the heparin group 2 (2%) patients developed non-Q-wave myocardial infarction and one patient (1%) underwent emergency CABG during the same hospitalization. The difference between groups regarding secondary end points was not statistically significant (P = 0.44). CONCLUSION:Heparin infusion after successful coronary interventions could increase the occurrence of bleeding and vascular injury; however, omission of heparin after a successful procedure did not significantly increase the incidence of ischaemic complications. Thus routine post-procedure heparin is not recommended.