Heparin dose during percutaneous coronary intervention: how low dare we go?

The Relationship of Body Mass Index to Outcomes after Percutaneous Coronary Intervention

“…UFH remains the standard procedural anticoagulant; clinical and traditional practice may have considerable influence over UFH dose selection 13,14 . In general, UFH was not more than 70–100 U/kg and there was a fixed standard dose range with the initial bolus dose between 5,000 and 10,000 U.…”

“…12 UFH remains the standard procedural anticoagulant; clinical and traditional practice may have considerable influence over UFH dose selection. 13,14 In general, UFH was not more than 70-100 U/kg and there was a fixed standard dose range with the initial bolus dose between 5,000 and 10,000 U. It should be noted that compared with UFH as the standard adjunctive antithrombin therapy, previous studies have shown that ultra-low doses of heparin, or other antithrombin agents such as bivalirudin used with selective GP IIb/IIIa inhibitors during PCI have been associated with less bleeding complications.…”

Periprocedural Management and In‐Hospital Outcome of Patients with Indication for Oral Anticoagulation Undergoing Coronary Artery Stenting

“…Since excessive anticoagulation deriving from both ongoing effective OAC and standard doses of intravenous unfractionated heparin may increase the risk of bleeding, it appears prudent to keep the heparin dose as low as possible (i.e., 30 to 50 IU/kg). 22 No additional anticoagulation should be given to patients referred for elective PCI-S while on effective OAC. Accordingly, the vast majority of our patients received an intravenous bolus of unfractionated heparin at the beginning of PCI-S.…”

“…In the urgent/emergency setting therefore, heparin administration appears reasonable, whether or not the current INR level is known. Since excessive anticoagulation deriving from both ongoing effective OAC and standard doses of intravenous unfractionated heparin may increase the risk of bleeding, it appears prudent to keep the heparin dose as low as possible (i.e., 30 to 50 IU/kg) 22 . No additional anticoagulation should be given to patients referred for elective PCI‐S while on effective OAC.…”

Antithrombotic therapy after coronary stenting in patients with indication for oral anticoagulation: Reply

“…Regardless of the awareness or not of the current INR level upon presentation, a definite heparin policy cannot be recommended. Although initial data derived from ongoing international registries suggest that the most common practice is to administer anyway full-dose intravenous heparin, it appears more reasonable and prudent to give heparin, albeit at a reduced dose (≤50 U/kg) since even very low doses have been shown effective in the setting of percutaneous coronary intervention [10]. Because of its mechanism of action, clopidogrel is a more potent inhibitor of platelet aggregation than aspirin, so its combination with oral anticoagulants has been advocated in patients on oral anticoagulation [11].…”