High Dose Bolus Heparin as Initial Therapy Before Primary Angioplasty for Acute Myocardial Infarction: Results of the Heparin in Early Patency (HEAP) Pilot Study

Verheugt, Freek W.A.; Liem, Aylee; Zijlstra, Felix; Marsh, Randall C.; Veen, Gerrit; Bronzwaer, Jean G.F.

doi:10.1016/s0735-1097(97)00495-6

Cited by 45 publications

(24 citation statements)

References 16 publications

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“…15 In this study, it is observed that 0-1 TIMI flow before intervention obviously in case group was more than control group (99% versus 91.6%) but after intervention there was no significant difference between two groups (3% versus 1.1%). This expresses that the influence of primary PCI in treatment of STEMI patients and improvement of their clinical situation while heparin injection before PCI doesn't effect on the treatment.…”

Section: Vd 2--3 Vdmentioning

confidence: 52%

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

Zamani

Abdollahi

Mardi

2018

Int J Basic Clin Pharmacol

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INTRODUCTIONCoronary artery disease (CAD) is the main cause of death, morbidity and disability in the world and their prevalence is highly increasing in developing countries. In CAD patients, acute coronary syndrome (ACS) has the most importance because of the high possibility of unpleasant cardiovascular events during follow-up was more in these patients. In 2008, 7.3 million (12.8%) out of 57 million deaths was because of myocardial infraction. In the United States, almost 650 thousand patients get new acute myocardial infraction (AMI) per year. The rate of early death (30 days) with AMI is about 30% and more than half of these cases occur before reaching to the hospital. 1,2During the last two decades, the rate of the death of coronary disease is decreasing in developed countries, whereas it is increasing in developing countries which is mostly because of long lifetime, urbanization and lifestyle changes. In the United States, the adjusted rate of death based age due to coronary disease has been declined to two third in four last decades which is the reflection of better diagnosis and reduce risk factors and also improvement of faster ABSTRACT Background: Primary PCI (PPCI) is the main reperfusion treatment for STsegment elevation myocardial infarction (STEMI). Anticoagulation therapy should be administered in patients undergoing PCI in order to limit the ischemic complications. In this study, we evaluated the effect of bolus unfractionated heparin (UFH) before PPCI on clinical outcome of patients with STEMI. Methods: In this randomized clinical trial, 196 patients (72.4% male with mean age of 63.02±13.37 years) with STEMI undergoing PPCI were randomly assigned to receive bolus UFH 60-90 U/kg in emergency room (case group) or during PCI (control group). Clinical outcomes, 30 day mortality, hematoma, left ventricle function improvement during follow-up were compared between groups. Results: In both groups there was good flow in the involved coronary artery after PCI. Case group compared to control group had significantly more cases with improved LVEF (28.1% vs. 9.7%, p=0.005). Also, case group compared to control group had more hematoma (3.1% vs. 0%, p=0.24) and higher mortality rate (6% vs. 4.2%, p=0.56) which had no significant difference between groups. Conclusions: PPCI in patients with STEMI accompanies with acceptable coronary flow irrespective of receiving bolus heparin. Receiving bolus heparin in these patients may have improved left ventricle function by increasing the rate of reflow. However, using bolus heparin did not accompany with increased rate of bleeding and had no effect on 30 day mortality rate.

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Section: Vd 2--3 Vdmentioning

confidence: 52%

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

Zamani

Abdollahi

Mardi

2018

Int J Basic Clin Pharmacol

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“…[7][8][9][10] Of these 3 patients, 2 who had been treated with abciximab experienced profuse bleeding in the oral cavity or at a tracheostomy site, and both required a massive blood transfusion after PCI, but finally succumbed to hypovolemic shock. The other patient, who had not been treated with abciximab, developed retroperitoneal hematoma and recovered from transient hypovolemic shock after a blood transfusion.…”

Section: Bleeding Complicationsmentioning

confidence: 99%

“…5,6 However, the role of adjunctive heparin in patients treated with primary PCI is not well established, with the few previous studies showing variable results. [7][8][9][10] Therefore, we investigated the effect of the early administration of heparin in the emergency room (ER) on both initial infarct-related artery (IRA) patency and clinical outcome in patients with STEMI treated by primary PCI.…”

mentioning

confidence: 99%

Effects of the Early Administration of Heparin in Patients With ST-Elevation Myocardial Infarction Treated by Primary Angioplasty

Chung

Han

Cho

et al. 2007

Circ J

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Background The effect of adjunctive heparin for primary angioplasty in patients with ST-elevation myocardial infarction (STEMI) is not well established, so the authors investigated the effect of early heparin administration in the emergency room (ER) on initial patency of the infarct-related artery (IRA) and on the clinical outcome in STEMI patients. Methods and Results One hundred and twenty consecutive patients who presented with STEMI less than 12 h from pain onset and who were eligible for primary percutaneous coronary intervention were allocated to an early heparin group (heparin administered in ER) or a late heparin group (heparin administered after angiography). In the early heparin group, unfractionated heparin (60 U/kg bolus IV, then 14 U·kg -1 ·h -1 IV infusion) or enoxaparin (1 mg/kg bolus SC) were administered 144±95 min before angioplasty. No significant differences in baseline characteristics were observed between the early heparin group (n=56) and the late heparin group (n=64). However, initial Thrombolysis In Myocardial Infarction (TIMI) flow grade in the IRA was significantly different between the 2 groups (frequency of TIMI 0/1/2/3; 48/4/7/41% vs 70/8/11/11%, early vs late respectively, p=0.002). TIMI 2 or 3 flow was significantly more frequent in the early heparin group than in the late heparin group (48% vs 22%, p=0.002). However, no significant differences were noted between the 2 groups in terms of in-hospital major adverse cardiac events (7% vs 11%, p=0.472) and TIMI major bleeding (2% vs 3%, p=0.639). Conclusions In STEMI patients, early heparin therapy administered in the ER improves coronary patency, despite not reaching clinical benefit. (Circ J 2007; 71: 862 -867)

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“…One study shows that an intravenous bolus of high-dose heparin administered in the emergency room improves TIMI flow before primary PCI. 25) In practice, we usually administer heparin and antiplatelet agents immediately after diagnosing AMI in the emergency room. As a result, the proportion of patients with TIMI 0 flow at initial CAG decreased to about 60% in both groups.…”

Section: Duration Of Reperfusion Therapymentioning

confidence: 99%

Effect of Hospital Case Volume on Treatment and In-Hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Results From the Ibaraki Coronary Artery Disease Study (ICAS) Registry

et al. 2008

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SUMMARYThe volume of percutaneous coronary interventions (PCI) performed in a hospital has been suggested to correlate with favorable outcomes in patients undergoing primary PCI for acute myocardial infarction (AMI). However, studies that use current data and compare treatment and outcomes for AMI among hospitals with different volumes are still limited in Japan.Between January 2004 and March 2006, 401 AMI patients underwent primary PCI in the 11 hospitals participating in the Ibaraki Coronary Artery Disease Study (ICAS). Clinical characteristics, treatment, and in-hospital outcomes were retrospectively compared between 254 patients admitted to high-volume PCI hospitals and 147 patients admitted to low-volume hospitals. Low-volume hospitals had a higher prevalence of multivessel disease patients. High-volume hospitals had longer onset-to-door times, which were offset by faster door-to-balloon times. Rates of coronary stent use and successful PCI were comparable between the groups. Low-volume hospitals more frequently performed intra-aortic balloon pumping. Length of stay was longer in low-volume hospitals, whereas in-hospital mortality, bypass surgery, and repeat PCI rates did not differ between groups.Although the present study assessed limited data based on small sample size, we observed that contemporary standard treatments including stent implantation were performed for AMI patients undergoing primary PCI in hospitals with both high and low case volumes. We did not find an obvious relationship between hospital PCI volume and inhospital outcomes in our data. However, further prospective surveys should be attempted to confirm these results. (Int Heart J 2008; 49: 249-260)

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High Dose Bolus Heparin as Initial Therapy Before Primary Angioplasty for Acute Myocardial Infarction: Results of the Heparin in Early Patency (HEAP) Pilot Study

Cited by 45 publications

References 16 publications

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

Effects of the Early Administration of Heparin in Patients With ST-Elevation Myocardial Infarction Treated by Primary Angioplasty

Effect of Hospital Case Volume on Treatment and In-Hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Results From the Ibaraki Coronary Artery Disease Study (ICAS) Registry

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