The role of heparin anticoagulation during intra-aortic balloon counterpulsation in the coronary care unit.
BACKGROUND
The benefit of heparin anticoagulation in patients undergoing intra-aortic balloon counterpulsation (IABP) is unproven.


METHODS
We determined the net clinical benefit (or harm) of heparin therapy during intra-aortic balloon counterpulsation (IABP) in the coronary care unit (CCU) by conducting a prospective "before-and-after" analysis of consecutive patients. We compared a universal heparin (UH) strategy (all patients given heparin) to a selective heparin (SH) strategy (heparin only for a clinical indication).


RESULTS
There were 102 patients in the UH group and 150 patients in the SH group. Among the SH group, 70 patients (47%) received no heparin. Major IABP-related complications were uncommon in both groups (2.9% versus 4.6%, P=0.7). Major limb ischemia occurred in one patient in the UH group (overall incidence: 0.4%). Major non-access-site bleeding was more common in the UH group (10.8% versus 3.3%, P=0.02). Inclusion in the UH group was independently associated with the endpoints of: major limb ischemia or any major bleeding (odds ratio (OR) 3.32, P=0.03), any major bleeding (OR 3.35, P=0.03), and major limb ischemia, any major bleeding, or death (OR 2.17, P=0.03).


CONCLUSIONS
Among CCU patients undergoing IABP, a selective heparin strategy appears to be superior to a strategy of universal heparin use.
Cooper
Howard A
HA
Coronary Care Unit, Washington Hospital Center, 110 Irving Street NW, Suite NA-1103, Washington, DC 20010, USA. howard.a.cooper@medstar.net
Thompson
Elissa
E
Panza
Julio A
JA
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D003325:Coronary Care Units; D005260:Female; D006470:Hemorrhage; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000379:methods*; D007511:Ischemia / Q000188:drug therapy*; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D013923:Thromboembolism; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin