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.