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July 12, 2026Current Cardiology Reports

UFH remains the standard PCI anticoagulant, with enoxaparin and bivalirudin serving as effective alternatives.

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Why the study?

Intraprocedural anticoagulation in the cardiac catheterization laboratory is essential to prevent thrombus formation on equipment while minimizing bleeding risk, warranting a summary of contemporary evidence and guideline recommendations.

Design

Review

Key result

Unfractionated heparin remains the standard intraprocedural anticoagulant during PCI, with enoxaparin and bivalirudin as effective alternatives depending on clinical presentation and bleeding risk.

Authors

TATanawat AttachaipanichTATania AhujaSSSamin K. Sharma

Discussion

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Overview

Reinforces UFH as PCI standard with risk-tailored alternatives; confirms consensus yet leaves open need for updated RCTs.

Key Points

  • This review aims to summarize current evidence and recommendations for anticoagulation in the cardiac catheterization laboratory.
  • Review of contemporary evidence and guidelines for anticoagulation during diagnostic catheterization and PCI.
  • Analysis of standard and alternative anticoagulants including UFH, LMWH, and bivalirudin in various clinical settings.
  • Evaluation of bleeding risks and thrombus formation prevention strategies.
  • UFH remains the standard agent, dosed at 50–100 U/kg intravenous bolus for PCI.
  • Enoxaparin provides predictable anticoagulation for stable CAD and NSTE-ACS, while bivalirudin is preferred for STEMI to reduce bleeding and mortality.
  • Fondaparinux should not be used as a stand-alone for intraprocedural anticoagulation due to increased catheter-related thrombosis risk.

Structured PICO

P
Population
Patients undergoing diagnostic catheterization and percutaneous coronary intervention (PCI) in the settings of stable coronary artery disease (CAD), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI)
I
Intervention
Intraprocedural anticoagulation strategies including unfractionated heparin (UFH), low-molecular-weight heparin (enoxaparin), bivalirudin, and fondaparinux

This review highlights that while UFH is the standard intraprocedural anticoagulant for PCI, bivalirudin and enoxaparin serve as effective alternatives tailored to patient presentation and bleeding risk.

Cite This Study

Attachaipanich et al. (2026) conducted a review in Diagnostic catheterization and percutaneous coronary intervention (PCI). Intraprocedural anticoagulation strategies was evaluated. Unfractionated heparin remains the standard intraprocedural anticoagulant during PCI, with enoxaparin and bivalirudin as effective alternatives depending on clinical presentation and bleeding risk.

synapsesocial.com/papers/6a5335404f7abc118adee356https://doi.org/10.1007/s11886-026-02388-y
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