[Heparin in coronary angioplasty. Randomized study in cases with low risk of acute occlusion].
OBJECTIVE
To assess the efficacy of heparin in preventing the abrupt closure after coronary angioplasty in low risk patients for this phenomenon.


METHODS
In the last 4 years, 525 patients successfully dilated were randomized to receive intravenous heparin (n = 264) or not (n = 261) after the angioplasty. The excluding criteria were contraindications for heparin and risk for abrupt closure (refractory unstable angina, primary coronary angioplasty in acute myocardial infarction, evidence of intracoronary thrombus, intimal tear after the procedure and cases of chronic total occlusions). Both heparin and non heparin groups were similar in respect to female sex (15% x 17%; p = NS), age over 70 years old (7% x 9%; p = NS), previous myocardial infarction (26% x 24%; p = NS), multi-vessel procedures (4% x 7%; p = NS, stable angina (40% x 46%; p = NS), unstable angina (52% x 48%; p = NS) and angioplasty after thrombolytic therapy (8% x 6%; p = NS).


RESULTS
The overall incidence of abrupt closure was 2/525 (0.4%), with one case (0.4%) in each group. The in-hospital mortality was 1/525 (0.2%), which occurred in a non-heparin patient, due to a anterior myocardial infarction. Major complications occurred similarly in heparin and non-heparin groups (0.4%). Bleeding complications were observed more frequently in the heparin group (7% x 2%; p = 0.002). All of them were in the catheterization site and none required blood transfusion. Severe systemic bleeding were not observed.


CONCLUSIONS
In patients regarded as low risk for abrupt closure, the incidence of this complication was really low (0.4%) and heparin probably do not prevent it.
Tanajura
L F
LF
Instituto Dante Pazzanese de Cardiologia, São Paulo.
Sousa
A G
AG
Pinto
I M
IM
Chaves
A J
AJ
Centemero
M P
MP
Feres
F
F
Mattos
L A
LA
Cano
M N
MN
Maldonado
G A
GA
Sousa
J E
JE
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000517:prevention & control*; D000075202:Contraindications; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D017202:Myocardial Ischemia / Q000150:complications; D011446:Prospective Studies
D006493:Heparin
Heparina na angioplastia coronária. Estudo randomizado em casos com baixo risco para lclusão aguda.