Addition of heparin to contrast media is associated with increased bleeding and peripheral vascular complications during percutaneous coronary intervention with bivalirudin and drug-eluting stents.
BACKGROUND
Nonionic radiographic contrast media (CM) is reported to be thrombogenic while performing diagnostic or interventional procedures. To avoid thrombosis, heparin is often added to the CM. Bivalirudin, used to replace heparin during percutaneous coronary intervention (PCI), is reported to be associated with reduced bleeding complications. We aimed to evaluate the impact of adding heparin to the CM during PCI in patients (pts) who underwent sirolimus-eluting stent (SES) implantation when bivalirudin was utilized as the sole antithrombotic agent.


METHODS
A total of 664 pts with 756 lesions underwent standard PCI with SES for various coronary artery lesions. Pts were treated with either bivalirudin only (the bivalirudin group; 0.75 mg/kg bolus and 1.75 mg/kg/h infusion, n = 323 pts) or bivalirudin (same dose) plus low-dose heparin added to the CM (the heparin mix group; mean dose = 2101.8+/-882.5 U, n = 341 pts) during PCI. The periprocedural, in-hospital, and 30-day clinical outcomes were compared.


RESULTS
Baseline clinical and angiographic parameters were similar between both groups. Periprocedural, in-hospital, and 1-month clinical outcomes, including thrombotic complications, were similar between the two groups. There was no difference in the periprocedural thrombosis rate between the groups. In the heparin mix group, the overall incidence of hematoma was significantly higher (3.8% vs. 8.5%, P = .01), there was a trend toward higher rates of blood transfusion (2.6% vs. 6.6%, P = .06) and overall vascular complications (0.01% vs. 5.3%, P <.001), including pseudoaneurysm (PSA; 0.0% vs. 2.6%, P = .004), and pts who required surgical repair (0.3% vs. 1.8%, P = .07).


CONCLUSIONS
The routine addition of low-dose heparin to CM during contemporary PCI does not add any protection value and is associated with higher rates of bleeding and vascular complications.
Division of Cardiology, Washington Hospital Center, 110 Irving Street, NW Suite 4B-1, Washington, DC 20010, USA.
Seung-Woon
SW
Rha
Pramod K
PK
Kuchulakanti
Rajbabu
R
Pakala
Edouard
E
Cheneau
Ellen
E
Pinnow
Afework
A
Gebreeyesus
George
G
Aggrey
Augusto D
AD
Pichard
Lowell F
LF
Satler
Kenneth M
KM
Kent
Joseph
J
Lindsay
Ron
R
Waksman
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D016491:Peripheral Vascular Diseases / Q000139:chemically induced*; D011183:Postoperative Complications / Q000139:chemically induced; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D003287:Contrast Media; D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin; D020123:Sirolimus