Low-dose heparin does not improve PCI outcomes

6 September 2010

MedWire News: Low-dose heparin does not improve the outcome of percutaneous coronary intervention (PCI) among patients with acute coronary syndromes (ACS) treated with fondaparinux, compared with the activated clotting time (ACT)-guided standard-dose, say researchers.

In their study of 2026 patients with non–ST elevation ACS initially treated with fondaparinux, Sanjit Jolly (McMaster University, Hamilton, Ontario, Canada) and colleagues compared the safety of two unfractionated heparin (UFH) regimens during PCI.

The patients, from 179 hospitals in 18 countries, were randomly assigned to receive low-dose UFH, 50 U/kg, regardless of use of glycoprotein IIb/IIIa (GpIIb-IIIa) inhibitors, or standard-dose UFH, 85 U/kg (60 U/kg with GpIIb-IIIa inhibitors), adjusted by blinded ACT.

The researchers report that combined major or minor bleeding, and major vascular access-site complications up to 48 hours after PCI was similar among low and standard UFH patients, at 4.7% and 5.8%, respectively.

When each component was assessed individually, Jolly and team found that the rates of major bleeding did not differ between the low- and standard-dose groups, at 2.2% versus 1.8%, respectively, but significantly fewer patients in the low-dose group had minor bleeding compared with the standard dose group, at 0.7% versus 1.7%.

In addition, there was a non-significant increase in the key secondary outcomes of peri-PCI major bleeding, death, myocardial infarction, and target revascularization at 30 days among patients in the low-dose group compared with the standard-dose group, at 5.8% versus 3.9%.

The authors note that catheter thrombus rates were very low and did not differ significantly between the groups, at 0.5% versus 0.1% in the low- and standard-dose groups, respectively.

The major finding of the present study is that low fixed-dose heparin is not superior to standard ACT-guided heparin dosing (after the use of fondaparinux) in terms of preventing peri-PCI major bleeding or major vascular access site complications, remark Jolly et al.

“Therefore, patients with acute coronary syndromes treated with fondaparinux and undergoing PCI should receive the guideline-recommended ACT-guided standard dose of UFH,” they conclude in the Journal of the American Medical Association.

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JAMA 2010; Advance online publication