A randomized pilot study of dalteparin versus unfractionated heparin during percutaneous coronary interventions.
BACKGROUND
Direct comparison of low-molecular-weight heparin, dalteparin, with unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) is limited. This study examined the relative effects of dalteparin and UFH on coagulation and angiographic and clinical indices during PCI.


METHODS
This was a double-blind randomized study, stratified by planned glycoprotein IIb/IIIa inhibitor use. Both UFH and dalteparin were administered as an intra-arterial bolus immediately before PCI.


RESULTS
All randomized patients received the assigned study drug and underwent PCI. Mean activated clotting time levels were 344 seconds for UFH and 234 seconds for dalteparin (P < .0001). Anti-factor Xa levels were higher for dalteparin at 30 minutes (UFH 1.3 IU/mL vs dalteparin 1.7 IU/mL, P = .005)) and at 4 hours (UFH 0.27 IU/mL vs dalteparin 0.69 IU/mL, P < .0001). Angiographic success was > 90% in both groups, and angiographic complications were similar (UFH 2.5% vs dalteparin 3.8%). The composite of death, myocardial infarction, target vessel revascularization, or bailout glycoprotein IIb/IIIa at hospital discharge was 13.7% in the UFH group and 13.1% in the dalteparin group (P = not significant). There were 2 major bleedings requiring transfusion, both occurring in the UFH group.


CONCLUSIONS
This study suggests that a single intra-arterial bolus of low-molecular-weight heparin without monitoring is feasible and warrants further investigation as an alternative to UFH during PCI.
Natarajan
Madhu K
MK
Division of Cardiology, Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. natarajm@ccc.mcmaster.ca
Velianou
James L
JL
Turpie
Alexander G G
AG
Mehta
Shamir R
SR
Raco
Dominic
D
Goodhart
David M
DM
Afzal
Rizwan
R
Ginsberg
Jeffrey S
JS
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use*; D017985:Dalteparin / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects
D000925:Anticoagulants; D006493:Heparin; D017985:Dalteparin