ASEAN Heart Journal

Intended for healthcare professional

Debate

ASEAN Heart Journal

April 2014, 22:8

First online: 04 December 2014

Debate

Opposition: Unfractionated heparin should no longer be used in the catheterization laboratory

Moo Hyun Kim,1 Young Seok Lee,2 Michael S. Lee3
Open Access
This content is freely available to anyone, anywhere at any time.
  • Summary
  • Supplementary Material
  • References
  • About this Article

Introduction

The goal of anticoagulation during percutaneous coronary intervention (PCI) is the primary and secondary prevention of thrombotic and significant bleeding events that increase cardiovascular morbidity and mortality. Unfractionated heparin is the most commonly-used anticoagulant, but low-molecular weight heparin, and more recently bivalirudin are becoming increasingly popular in cardiac catheterization laboratories(1).

The ACC/AHA/SCAI PCI guidelines2 recommend a 70-100 IU/kg bolus of heparin to achieve an activated clotting time (ACT) of 250-300 seconds for Hemotec and 300-350 seconds for Hemochron systems, when glycoprotein IIb/IIIa inhibitors are not used. When glycoprotein IIb/IIIa inhibitors are used, a bolus of 50-70 IU/kg of unfractionated heparin is recommended to achieve an ACT of 200-250 seconds.

Keywords
Percutaneous Coronary Intervention - Enoxaparin - Unfractionated Heparin - Fondaparinux - Bivalirudin


Moo Hyun Kim, Director, Regional Clinical Trial Center, Professor; Dept. of Cardiology, Dong-A University Hospital, 3-1, Dongdaeshin-Dong, Seo-Gu, Busan, Korea 602-715

Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Supplementary Material

Nil

 

References

1. Appleton DL, Cooke RH, Rao SV, Jovin IS.¬†Anticoagulation in transradial percutaneous coronary intervention.¬†Catheter Cardiovasc Interv¬†2014;83(2):237‚Äď42. PubMed¬† ¬†CrossRef

2. Levine GN, Bate ER, Blankenship JC, et al.¬†2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.¬†Circulation¬†2011;124: e574‚Äďe651. CrossRef

3. White HD, Kleiman NS, Mahaffey KW, et al.¬†Efficacy and safety of enoxaparin compared with unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention in the Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial.¬†Am Heart J¬†2006; 152: 1042‚Äď50. PubMed¬† ¬†CrossRef

4. Fifth Organization to Assess Strategies in Acute Ischemic Syndromes investigators.¬†Comparison of fondaparinux and enoxaparin in acute coronary syndromes.¬†N Engl J Med¬†2006; 354: 1464‚Äď76. CrossRef

5. Lincoff AM, Bittl JA, Harrington RA, et al,¬†for the REPLACE-2 investigators. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial.¬†JAMA¬†2003; 289: 853‚Äď63. PubMed ¬†CrossRef

6. Stone GW, Witzenbichler B, Guagliumi G, et al.¬†HORIZONS-AMI Trial Investigators. Bivalirudin during primary PCI in acute myocardial infarction.¬†N Engl J Med¬†2008;358:2218‚Äď30. PubMed¬† ¬†CrossRef

7. Kim MH, Yu LH, Tanaka H, Mitsudo K.¬†Experience with a novel retrograde wiring technique for coronary chronic total occlusion.¬†J Interv Cardiol¬†2013;26(3):254‚Äď8. PubMed¬† ¬†CrossRef

8. Muramatsu T. Current technical and clinical features of the antegrade and retrograde approaches to percutaneous transluminal coronary intervention for chronic total occlusion-2013 version. Syllabus of TOPIC meeting 2013. p179.

9. Sharman S, Patel S, Behl A, et al. Extensive Fatal Intracoronary Thrombosis During Percutaneous Coronary Intervention With Bivalirudin. Am J Ther 2013 Jul 25 [Epub ahead of print].

10. Stone GW, McLaurin BT, Cox DA, et al,¬†for the ACUITY investigators. Bivalirudin for patients with acute coronary syndromes.¬†N Engl J Med¬†2006; 355: 2203‚Äď16. PubMed¬† ¬†CrossRef

11. Dangas GD, Mehran R, Nikolsky E, et al.¬†Effect of switching anti-thrombotic agents for primary angioplasty in acute myocardial infarction. The HORIZONS-SWITCH analysis.¬†J Am Coll Cardiol¬†2011;57:2309‚Äď2316. PubMed¬† ¬†CrossRef

12. Koutouzis M, Lagerqvist B, James S, et al.¬†Unfractionated heparin administration in patients treated with bivalirudin during primary percutaneous coronary intervention is associated lower mortality and target lesion thrombosis: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).¬†Heart¬†2011;97 (18):1484‚Äď8. PubMed¬† ¬†CrossRef ‚Äč

13. Langrish JP, Fox KAA.¬†Optimal antithrombotic treatment during primary percutaneous coronary intervention?¬†Heart¬†2011;97:1459‚Äď60. PubMed¬† ¬†CrossRef

14. Shahzad A, Cooper RM, Stables RH.¬†Anthithrombotic therapy in PCI: Why not heprin?¬†Eurointervention¬†2013;22:423‚Äď6. CrossRef

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About this Article

Title
Opposition: Unfractionated heparin should no longer be used in the catheterization laboratory


Open Access
Available under Open Access


Journal >> 22:1


Online Date
21 November 2019


DOI
10.7603/s40602-014-0007-z


Online ISSN
2315-4551


Publisher
ASEAN Federation of Cardiology
Additional Links Cardiology


Keywords
Percutaneous Coronary Intervention
Enoxaparin
Unfractionated Heparin
Fondaparinux
Bivalirudin


Author Affiliations
1. Dept. of Cardiology, Dong-A University Hospital, Busan, Korea
2. Departments of Pediatrics, Dong-A University Hospital, Busan, Korea
3. UCLA Medical Center, Los Angeles, CA, USA


Correspondence to:
Moo Hyun Kim,[email protected]