In-hospital complications of peripheral vascular interventions using unfractionated heparin as the primary anticoagulant.
Unfractionated heparin is the current antithrombotic of choice in peripheral vascular interventions. The rate of in-hospital major complications during peripheral angioplasty procedures (PTA) using heparin as the primary anticoagulant has not been well defined. In this single-center study, the charts of 213 consecutive PTA procedures in a 1-year period were reviewed. Of unstaged procedures, a total of 131 patients (57.3% males; mean age, 66.4   12.1 years) met inclusion criteria. Forty-five patients (34.4%) had recent onset of claudication and 15 (11.5%) had ulceration. Thrombus was angiographically visualized in 16.7% of patients. Unfractionated heparin was administered at a mean of 4,672   1,238 U (59.1   20.0 U/kg) during the procedure. The highest activated clotting time (ACT) during the procedure was recorded in 114 patients. ACTs were < 300, 300 400 and > 400 seconds in 29.0%, 29.0% and 42.1%, respectively. In-hospital clinical events occurred in 12 patients (9.2%) who met any one of the following endpoints: death (0.8%), limb loss (1.5%), major bleeding (4.6%), emergent need for repeat revascularization of the same vessel (7.6%), embolic stroke (0.0%) and vascular complications (1.5%). The best model associated with salvage revascularization included cigarette smoking within the past year, recent onset of claudication and PTA treatment below the knee. Increased dosages of heparin (U/kg) were associated with a trend toward higher rates of complications. A significant number of patients have in-hospital major complications following PTA procedures using unfractionated heparin as the primary anticoagulant. Current ongoing registries are evaluating the feasibility of direct thrombin inhibitors bivalirudin instead of heparin as a primary anticoagulant during PTA.
Shammas
Nicolas W
NW
Cardiovascular Medicine, PC, Genesis Heart Institute, 1236 E. Rusholme, Suite 300, Davenport, IA 52803, USA. shammas@mchsi.com
Lemke
Jon H
JH
Dippel
Eric J
EJ
McKinney
Dawn E
DE
Takes
Vickie S
VS
Youngblut
Monica
M
Harris
Melodee
M
Harb
Catherine
C
Kapalis
Matthew J
MJ
Holden
Jane
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006493:Heparin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology* / Q000401:mortality; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000628:therapy*; D011150:Popliteal Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin