Limits...
Opposition: Unfractionated heparin should no longer be used in the catheterization laboratory.

Kim MH, Lee YS, Lee MS - ASEAN Heart J (2014)

Bottom Line: Unfractionated heparin is the most commonly-used anticoagulant, but low-molecular weight heparin, and more recently bivalirudin are becoming increasingly popular in cardiac catheterization laboratories(1).The ACC/AHA/SCAI PCI guidelines(2) recommend a 70-100 IU/kg bolus of heparin to achieve an activated clotting time (ACT) of 250-300 seconds for Hemotec and 300-350 seconds for Hemochron systems, when glycoprotein IIb/IIIa inhibitors are not used.When glycoprotein IIb/IIIa inhibitors are used, a bolus of 50-70 IU/kg of unfractionated heparin is recommended to achieve an ACT of 200-250 seconds.

View Article: PubMed Central - PubMed

Affiliation: Dept. of Cardiology, Dong-A University Hospital, Busan, Korea.

ABSTRACT

The goal of anticoagulation during percutaneous coronary intervention (PCI) is the primary and secondary prevention of thrombotic and significant bleeding events that increase cardiovascular morbidity and mortality. Unfractionated heparin is the most commonly-used anticoagulant, but low-molecular weight heparin, and more recently bivalirudin are becoming increasingly popular in cardiac catheterization laboratories(1). The ACC/AHA/SCAI PCI guidelines(2) recommend a 70-100 IU/kg bolus of heparin to achieve an activated clotting time (ACT) of 250-300 seconds for Hemotec and 300-350 seconds for Hemochron systems, when glycoprotein IIb/IIIa inhibitors are not used. When glycoprotein IIb/IIIa inhibitors are used, a bolus of 50-70 IU/kg of unfractionated heparin is recommended to achieve an ACT of 200-250 seconds.

No MeSH data available.


Related in: MedlinePlus

Coronary intervention of retrograde approach in a 75 year old male patient. Distal right coronary artery was totally occluded (left upper) and was completed with 3 stents (right lower). During the procedure reverse CART (right upper, open arrow) and Rendevous procedures were performed. Prolonged dwell time with intracoronary hardware (wires, balloons, and stents, arrows) requires strict ACT-guided anticoagulation to prevent thrombotic events.
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Related In: Results  -  Collection


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Fig1: Coronary intervention of retrograde approach in a 75 year old male patient. Distal right coronary artery was totally occluded (left upper) and was completed with 3 stents (right lower). During the procedure reverse CART (right upper, open arrow) and Rendevous procedures were performed. Prolonged dwell time with intracoronary hardware (wires, balloons, and stents, arrows) requires strict ACT-guided anticoagulation to prevent thrombotic events.

Mentions: A 75 year-old male was admitted to the hospital due to exertional chest pain. He had a long history of hypertension, and a history of pancreatitis and cholecystitis. He suffered a non-ST elevation myocardial infarction 2 months prior and had stent insertion at the proximal and mid anterior descending artery prior to admission. His coronary angiogram showed total occlusion at the distal right coronary with TIMI grade 2 collateral flow from the left anterior descending coronary artery (Fig. 1. upper left). Intervention was attempted via both femoral punctures. An antegrade approach attempt using a microcatheter and several guidewires was unsuccessful. Therefore the retrograde approach was attempted using the Finecross microcatheter (Terumo co., Japan) and a dedicated hydrophilic guidewire using the septal channel. A retrograde guidewire was advanced into an antegrade 7 Fr AR II guiding catheter after reverse controlled antegrade and retrograde subintimal tracking (CART) technique (Fig. 1. upper right, open arrow). Using the Rendezvous technique7, the antegrade guidewire was inserted into the distal right coronary total occlusion sites (Fig. 1. left lower). Successful PCI was performed with 3 drug-eluting stents (Fig. 1 right lower). During the retrograde technique, the ACT was measured every 30-60 minutes to achieve a target ACT >300 sec in order to prevent thrombotic complications8.


Opposition: Unfractionated heparin should no longer be used in the catheterization laboratory.

Kim MH, Lee YS, Lee MS - ASEAN Heart J (2014)

Coronary intervention of retrograde approach in a 75 year old male patient. Distal right coronary artery was totally occluded (left upper) and was completed with 3 stents (right lower). During the procedure reverse CART (right upper, open arrow) and Rendevous procedures were performed. Prolonged dwell time with intracoronary hardware (wires, balloons, and stents, arrows) requires strict ACT-guided anticoagulation to prevent thrombotic events.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4544474&req=5

Fig1: Coronary intervention of retrograde approach in a 75 year old male patient. Distal right coronary artery was totally occluded (left upper) and was completed with 3 stents (right lower). During the procedure reverse CART (right upper, open arrow) and Rendevous procedures were performed. Prolonged dwell time with intracoronary hardware (wires, balloons, and stents, arrows) requires strict ACT-guided anticoagulation to prevent thrombotic events.
Mentions: A 75 year-old male was admitted to the hospital due to exertional chest pain. He had a long history of hypertension, and a history of pancreatitis and cholecystitis. He suffered a non-ST elevation myocardial infarction 2 months prior and had stent insertion at the proximal and mid anterior descending artery prior to admission. His coronary angiogram showed total occlusion at the distal right coronary with TIMI grade 2 collateral flow from the left anterior descending coronary artery (Fig. 1. upper left). Intervention was attempted via both femoral punctures. An antegrade approach attempt using a microcatheter and several guidewires was unsuccessful. Therefore the retrograde approach was attempted using the Finecross microcatheter (Terumo co., Japan) and a dedicated hydrophilic guidewire using the septal channel. A retrograde guidewire was advanced into an antegrade 7 Fr AR II guiding catheter after reverse controlled antegrade and retrograde subintimal tracking (CART) technique (Fig. 1. upper right, open arrow). Using the Rendezvous technique7, the antegrade guidewire was inserted into the distal right coronary total occlusion sites (Fig. 1. left lower). Successful PCI was performed with 3 drug-eluting stents (Fig. 1 right lower). During the retrograde technique, the ACT was measured every 30-60 minutes to achieve a target ACT >300 sec in order to prevent thrombotic complications8.

Bottom Line: Unfractionated heparin is the most commonly-used anticoagulant, but low-molecular weight heparin, and more recently bivalirudin are becoming increasingly popular in cardiac catheterization laboratories(1).The ACC/AHA/SCAI PCI guidelines(2) recommend a 70-100 IU/kg bolus of heparin to achieve an activated clotting time (ACT) of 250-300 seconds for Hemotec and 300-350 seconds for Hemochron systems, when glycoprotein IIb/IIIa inhibitors are not used.When glycoprotein IIb/IIIa inhibitors are used, a bolus of 50-70 IU/kg of unfractionated heparin is recommended to achieve an ACT of 200-250 seconds.

View Article: PubMed Central - PubMed

Affiliation: Dept. of Cardiology, Dong-A University Hospital, Busan, Korea.

ABSTRACT

The goal of anticoagulation during percutaneous coronary intervention (PCI) is the primary and secondary prevention of thrombotic and significant bleeding events that increase cardiovascular morbidity and mortality. Unfractionated heparin is the most commonly-used anticoagulant, but low-molecular weight heparin, and more recently bivalirudin are becoming increasingly popular in cardiac catheterization laboratories(1). The ACC/AHA/SCAI PCI guidelines(2) recommend a 70-100 IU/kg bolus of heparin to achieve an activated clotting time (ACT) of 250-300 seconds for Hemotec and 300-350 seconds for Hemochron systems, when glycoprotein IIb/IIIa inhibitors are not used. When glycoprotein IIb/IIIa inhibitors are used, a bolus of 50-70 IU/kg of unfractionated heparin is recommended to achieve an ACT of 200-250 seconds.

No MeSH data available.


Related in: MedlinePlus