Key result
GP IIb/IIIa antagonists without heparin during IABP support post-primary PCI resulted in a 3.1% vascular complication rate, 9% major bleeding, and 15.5% minor bleeding.
Why the study?
Anticoagulation with heparin is recommended during IABP use to prevent thrombosis, but it increases bleeding risk when combined with GP IIb/IIIa antagonists. The safety of using GP IIb/IIIa antagonists without concomitant heparin after IABP insertion in primary PCI patients needed investigation.
Observational (n=97)
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GP IIb/IIIa use without heparin after IABP warrants caution in primary PCI; leaves open need for RCTs to establish safety.
BACKGROUND: Anticoagulation with heparin is recommended with intra-aortic balloon pump (IABP) to prevent thrombosis and embolization. However, anticoagulation increases the risk of bleeding, particularly in combination with glycoprotein (GP) IIb/IIIa antagonists. HYPOTHESIS: We investigated the safety of using GP IIb/IIIa antagonists without heparin after IABP insertion in patients who underwent primary percutaneous coronary intervention (PCI). METHODS: Consecutive patients with acute myocardial infarction (AMI), who underwent primary PCI and were treated with GP IIb/IIIa antagonists without concomitant heparin, and in whom IABP was inserted, were followed during hospitalization for thrombotic and hemorrhagic complications. RESULTS: Ninety-seven patients were included in this analysis. Glycoprotein IIb/IIIa antagonist treatment duration was 12-24 h in 89% of patients, and IABP duration was up to 48 h in 97% of patients. Three patients (3.1%) developed vascular complications: 1 had a major limb ischemia (long IABP treatment), 1 had a minor limb ischemia, and 1 had a cerebrovascular event (after prolonged resuscitation). All patients were already on heparin at the time of the thrombotic events. The rates of major and minor bleeding complications were 9% and 15.5%, respectively. CONCLUSIONS: The rate of thrombotic complications is relatively low in post-primary PCI patients with IABP treated with GP IIb/IIIa antagonists without concomitant heparin therapy. Such an approach may reduce the risk of hemorrhagic complications, with low risk of thrombotic complications.
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Laish‐Farkash et al. (2009) conducted an observational in Acute myocardial infarction with intra-aortic balloon pump undergoing primary percutaneous coronary intervention (n=97). Glycoprotein IIb/IIIa antagonists without concomitant heparin during intra-aortic balloon pump support was evaluated on In-hospital vascular/thrombotic complications (and major and minor hemorrhagic complications). GP IIb/IIIa antagonists without heparin during IABP support post-primary PCI resulted in a 3.1% vascular complication rate, 9% major bleeding, and 15.5% minor bleeding.
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