title: Periprocedural prophylactic antithrombotic strategies in interventional radiology: current practice in the Netherlands and comparison with the United kingdom.
abstract: OBJECTIVE
  The use of prophylactic antithrombotic drugs to prevent arterial thrombosis during the periprocedural period during (percutaneous) peripheral arterial interventions (PAIs) is still a matter of dispute, and clear evidence-based guidelines are lacking. To create those guidelines, a study group was formed in the Netherlands in cooperation with the Dutch Society of Vascular Surgery and the Society of Interventional Radiology. The study group is called "Consensus on Arterial PeriProcedural Anticoagulation (CAPPA)."
  
  
  METHODS
  The CAPPA study group devised and distributed a comprehensive questionnaire amongst Dutch interventional radiologists (IRs).
  
  
  RESULTS
  One hundred forty-two IRs responded (68 %) to the questionnaire. Almost no IR stopped acetyl salicylic acid before interventions, and 40 % stopped clopidogrel before PAI but not before carotid artery stenting (CAS). A flushing solution on the sideport of the sheath was used routinely by 30 % of IRs in PAI and by 50 % of IRs during CAS. A minority of IRs used a heparinised flushing solution (28 %). Unfractionated heparin was used by 95 % of IRs as bolus; 5000 IU was the most used dosage. Timing of administration varied widely. A majority of IRs (75 %) repeated heparin administration after 1 h.
  
  
  CONCLUSIONS
  A substantial variety exists amongst IRs in the Netherlands regarding the use of prophylactic periprocedural antithrombotic drugs to prevent arterial thrombosis during PAI. When compared with varying results regarding the use of heparin in the United Kingdom, the variety in the Netherlands showed a different pattern. The proven variety in these countries, and also between these countries, emphasises the need for authoritative studies to develop evidence-based practical guidelines.
authors: Department of Surgery, Westfriesgasthuis, Hoorn, Maelsonstraat 3, 1624 NP, Hoorn, The Netherlands. arno@wiersema.nu.
authors: Arno M
authors: AM
authors: Wiersema
authors: Department of Radiology, Division of Interventional Radiology, St Antonius Hospital, Nieuwegein, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands.
authors: Jan-Albert
authors: JA
authors: Vos
authors: Department of Surgery, Equipe Zorg Bedrijven, Rotterdam, Luchthavenweg 81-235, 5657 EA, Eindhoven, The Netherlands.
authors: Cornelis M A
authors: CMA
authors: Bruijninckx
authors: Department of Radiology, Division of Interventional Radiology, Academic Medical Centre, University of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, The Netherlands.
authors: Otto M
authors: OM
authors: van Delden
authors: Department of Surgery, Rijnstate Hospital, Arnhem, Postbus 9555, 6800 TA, Arnhem, The Netherlands.
authors: Michel M P J
authors: MMPJ
authors: Reijnen
authors: Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, Postbus 95500, 1090 HM, Amsterdam, The Netherlands.
authors: Anco
authors: A
authors: Vahl
authors: Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Postbus 30001, 9700 RB, Groningen, The Netherlands.
authors: Clark J
authors: CJ
authors: Zeebregts
authors: Department of Surgery, Division of Vascular Surgery, University Medical Centre Utrecht, University of Utrecht, Postbus 85500, 3508 GA, Utrecht, The Netherlands.
authors: Frans L
authors: FL
authors: Moll
mesh_terms: D000077144:Clopidogrel; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009426:Netherlands; D019990:Perioperative Care / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015642:Radiology, Interventional / Q000379:methods*; D015607:Stents; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006113:United Kingdom; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine