title: A randomized pilot study of dalteparin versus unfractionated heparin during percutaneous coronary interventions.
abstract: 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.
authors.affiliation: Division of Cardiology, Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. natarajm@ccc.mcmaster.ca
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.forename: James L
authors.initials: JL
authors.lastname: Velianou
authors.forename: Alexander G G
authors.initials: AG
authors.lastname: Turpie
authors.forename: Shamir R
authors.initials: SR
authors.lastname: Mehta
authors.forename: Dominic
authors.initials: D
authors.lastname: Raco
authors.forename: David M
authors.initials: DM
authors.lastname: Goodhart
authors.forename: Rizwan
authors.initials: R
authors.lastname: Afzal
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Ginsberg
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D006493:Heparin; D017985:Dalteparin