title: Heparins crossover in percutaneous coronary interventions: a real issue with increasing rate of transradial procedures?
abstract: OBJECTIVE
  Current guidelines give a class III recommendation to the intraprocedural use of unfractionated heparin (UFH) in patients pretreated with enoxaparin. The aim of our study was to evaluate bleeding complications in patients who underwent percutaneous coronary interventions (PCIs) performed using intraprocedural crossover of heparin therapy.
  
  
  METHODS
  We retrospectively evaluated all PCIs performed at two Italian hospitals since January 2011 to December 2013. After a propensity-matched analysis, patients were divided into two groups (with a ratio 1 : 2) according to intraprocedural crossover of heparins (from enoxaparin to UFH) (Group 1) or intraprocedural UFH alone (Group 2). The primary end-point was a haemoglobin drop of at least 3 g/dl within 48 h after the procedure.
  
  
  RESULTS
  During the 3 years analysed, 3224 patients underwent PCI, and after the propensity analysis, 309 patients were considered eligible for our study: 104 patients in Group 1 (69 ± 12 years, 78% men) and 205 patients in Group 2 (69 ± 13 years, 80% men, P = NS). There were no significant differences between the two groups for BMI, periprocedural use of antiplatelet therapy, baseline haemoglobin haematocrit or platelets levels. The primary end-point did not differ between the two groups (2.9% in Group 1 and 3.4% in Group 2, P = 0.550). Also, nadir of haematocrit or haemoglobin levels did not differ between the two groups. Finally, in hospital, major adverse cardio-cerebrovascular events did not differ between the two groups (1.9% in Group 1 and 3.9% in Group 2, P = 0.50).
  
  
  CONCLUSIONS
  In this retrospective analysis of a large PCI database, the 'heparins crossover' during PCI was not associated with increased bleeding risk.
authors.affiliation: aDepartment of Interventional Cardiology, Sandro Pertini Hospital, ASL RMB bDepartment of Cardiology, University La Sapienza cEmergency Department, Sandro Pertini Hospital, ASL RMB, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.forename: Stefano
authors.initials: S
authors.lastname: Rigattieri
authors.forename: Simone
authors.initials: S
authors.lastname: Calcagno
authors.forename: Massimo
authors.initials: M
authors.lastname: Mancone
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pendenza
authors.forename: Maria
authors.initials: M
authors.lastname: Cera
authors.forename: Aurora Ilaria
authors.initials: AI
authors.lastname: Danza
authors.forename: Cristian
authors.initials: C
authors.lastname: Di Russo
authors.forename: Pasqualina
authors.initials: P
authors.lastname: Bruno
authors.forename: Silvio
authors.initials: S
authors.lastname: Fedele
authors.forename: Francesco Rocco
authors.initials: FR
authors.lastname: Pugliese
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D057915:Drug Substitution / Q000379:methods; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D019990:Perioperative Care / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D057216:Propensity Score; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin