Anticoagulation therapy in intra-aortic balloon counterpulsation: does IABP really need anti-coagulation?
OBJECTIVE
To investigate if intra-aortic balloon pump (IABP) is contraindicated without anticoagulation therapy.


METHODS
Some 153 IABP patients in the King Abdulaziz Cardiac Center (KSA) were randomly assigned into two groups. Anticoagulation group (Group A) consisted of 71 patients who were given heparin intravenously with target aPTT 50-70 seconds. Non-anticoagulation group (Group B) consisted of 82 patients without intravenous heparin during balloon pumping. Hematological parameters including platelet count, D-dimer, Plasminogen activator inhibitor-1 (PAI-1) and fibrinogen degradation products (FDP) were checked respectively at the point of baseline, 24 hours, 48 hours and 24 hours post IABP counterpulsation. Clot deposits on balloon surface, vascular complications from IABP including bleeding and limb ischemia were recorded.


RESULTS
Platelet count and PAI-1 level decreased at 24 hours and 48 hours in both groups (P<0.05). D-dimer and FDP level increased at 24 hours and 48 hours in both groups (P<0.05), but returned to the baseline level 24 hours post IABP removal (P>0.05). Three patients in Group A and 2 patients in Group B developed minor limb ischemia (P>0.05). No major limb ischemia in either group. Two patients in Group A suffered major bleeding and required blood transfusion or surgical intervention, whereas no patient had major bleeding in Group B. Eight patients had minor bleeding in Group A, but only 2 patients in Group B (P<0.05). No clot deposit developed on IABP surface in either group.


CONCLUSIONS
IABP is safe without routine anticoagulation therapy. Selecting appropriate artery approach and early detection intervention are key methods for preventing complications.
Jiang
Chen-yang
CY
Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China. jiangchenyang@hotmail.com
Zhao
Li-li
LL
Wang
Jian-an
JA
Mohammod
Balgaith
B
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001011:Aorta / Q000473:pathology*; D001158:Arteries; D001780:Blood Coagulation Tests; D015908:Counterpulsation; D005260:Female; D005340:Fibrinogen / Q000096:biosynthesis; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D007511:Ischemia / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000096:biosynthesis; D013997:Time Factors
D000925:Anticoagulants; D017395:Plasminogen Activator Inhibitor 1; D005340:Fibrinogen