title: Low-dose heparin for elective percutaneous coronary intervention.
abstract: OBJECTIVE
  We evaluated the safety and efficacy of low-dose heparin (40 IU/kg) for elective percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Current guidelines recommend a 70-100 IU/kg bolus of heparin for elective PCI, but this dose may be associated with increased bleeding risk. Low-dose heparin may have an advantage in this regard, but has not been well studied.
  
  
  METHODS
  From January 2008 to October 2012, 300 patients underwent elective transfemoral PCI and were treated with an initial bolus of 40 IU/kg of heparin at the UCLA Medical Center. Dual antiplatelet therapy with clopidogrel and aspirin was administered prior to or just after diagnostic coronary angiography. The primary end-point was the composite of cardiac death, myocardial infarction, urgent target vessel revascularization for ischemia, or major bleeding within 30 days after PCI.
  
  
  RESULTS
  The mean activating clotting time was 233 ± 28 seconds. The primary end-point occurred in 2.3%. The cardiac death rate was 0.3% but was not related to the PCI. The myocardial infarction rate was 1.3%. Urgent target vessel revascularization occurred in 1 patient (0.3%). The major bleeding rate was 0.3%. No stent thrombosis occurred.
  
  
  CONCLUSIONS
  Using a lower dose of heparin with dual antiplatelet therapy is safe and is associated with a low bleeding risk after transfemoral PCI while providing suppression of ischemic events. This may also represent a cost savings compared with other antithrombotic strategies. A randomized clinical trial comparing low-dose heparin with bivalirudin in patients is required to determine the optimal anticoagulation strategy.
authors.affiliation: UCLA Medical Center, Los Angeles, California.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Jared
authors.initials: J
authors.lastname: Oyama
authors.forename: Zahid
authors.initials: Z
authors.lastname: Iqbal
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006493:Heparin