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Interventional cardiology

Seeking the optimal heparin dose

Nature Reviews Cardiology volume 7, page 601 (2010)Cite this article

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Unfractionated heparin is the standard anticoagulant used in interventional cardiology. Despite being used for the past 20 years in patients undergoing percutaneous coronary intervention (PCI), there are insufficient data from randomized trials to guide the optimal dose during the procedure. Two large studies have now been published that investigate this issue.

In the first study, published in JAMA, the FUTURA/OASIS-8 trial investigators compared two regimens of unfractionated heparin during PCI in patients with acute coronary syndromes treated with the synthetic factor Xa inhibitor fondaparinux. The investigators had shown previously that fondaparinux was noninferior compared with enoxaparin for the primary outcome, but halved rates of bleeding. However, there was an increase in catheter-related thromboses in patients receiving fondaparinux. “We specifically designed the FUTURA/OASIS-8 trial to find the optimal dose of heparin to prevent catheter thrombosis and ischemic events during PCI, without increasing major bleeding in patients treated with fondaparinux,” says investigator Sanjit Jolly. Patients (n = 2,026) were randomly assigned to receive low-dose unfractionated heparin (50 U/kg, regardless of glycoprotein IIb/IIIa blocker use) or standard-dose unfractionated heparin (85 U/kg, or 60 U/kg with glycoprotein IIb/IIIa blocker use). The primary outcome was a composite of peri-PCI major bleeding, minor bleeding, or major vascular access site complications up to 48 h after PCI. No significant difference in the primary outcome was observed between low-dose and standard-dose heparin, and catheter thrombosis was rare in both groups; however, there was a trend for reduced efficacy with low-dose heparin, with an increased rate of ischemic complications.

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ORIGINAL RESEARCH PAPERS

  1. The FUTURA/OASIS-8 Trial Group. Low-dose vs standard-dose unfractionated heparin for percutaneous coronary intervention in acute coronary syndromes treated with fondaparinux: the FUTURA/OASIS-8 randomized trial. JAMA 304, 1339–1349 (2010)

  2. Schulz, S. et al. ISAR-REACT 3A: a study of reduced dose of unfractionated heparin in biomarker negative patients undergoing percutaneous coronary intervention. Eur. Heart J. doi:10.1093/eurheartj/ehq330

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  1. Helene Myrvang
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Myrvang, H. Seeking the optimal heparin dose. Nat Rev Cardiol 7, 601 (2010). https://doi.org/10.1038/nrcardio.2010.156

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