In-Hospital Complications of Peripheral Vascular Interventions
In-Hospital Complications of Peripheral Vascular Interventions
Unfractionated heparin is the current antithrombotic of choice in peripheral vascular interventions. The rate of in-hospital major complications during peripheral angioplasty procedures (PTA) using heparin as the primary anticoagulant has not been well defined. In this single-center study, the charts of 213 consecutive PTA procedures in a 1-year period were reviewed. Of unstaged procedures, a total of 131 patients (57.3% males; mean age, 66.4 ± 12.1 years) met inclusion criteria. Forty-five patients (34.4%) had recent onset of claudication and 15 (11.5%) had ulceration. Thrombus was angiographically visualized in 16.7% of patients. Unfractionated heparin was administered at a mean of 4,672 ± 1,238 U (59.1 ± 20.0 U/kg) during the procedure. The highest activated clotting time (ACT) during the procedure was recorded in 114 patients. ACTs were < 300, 300-400 and > 400 seconds in 29.0%, 29.0% and 42.1%, respectively. In-hospital clinical events occurred in 12 patients (9.2%) who met any one of the following endpoints: death (0.8%), limb loss (1.5%), major bleeding (4.6%), emergent need for repeat revascularization of the same vessel (7.6%), embolic stroke (0.0%) and vascular complications (1.5%). The best model associated with salvage revascularization included cigarette smoking within the past year, recent onset of claudication and PTA treatment below the knee. Increased dosages of heparin (U/kg) were associated with a trend toward higher rates of complications. A significant number of patients have in-hospital major complications following PTA procedures using unfractionated heparin as the primary anticoagulant. Current ongoing registries are evaluating the feasibility of direct thrombin inhibitors bivalirudin instead of heparin as a primary anticoagulant during PTA.
Unfractionated heparin is the current antithrombotic of choice in peripheral vascular interventions. Heparin has an unpredictable anticoagulation response, is an indirect thrombin inhibitor, does not inhibit bound thrombin and activates platelets. A contemporary in-hospital complication rate following percutaneous transluminal peripheral angioplasty (PTA) has not been well defined with the use of unfractionated heparin as the initial primary anticoagulant. In-hospital complication rates following PTA have been reported in the literature; they range from 3.5% to as high as 32.7%.1-7 These studies differed in their inclusion and exclusion criteria, designs, and patient numbers and characteristics, and undertook no consistent reporting on anticoagulation regimen utilized. Given the continuous search for a better anticoagulant than heparin during percutaneous interventions, it is important to define our current baseline complication rate during PTA with heparin as the primary anticoagulant.
In this single-center experience, we report on our complication rate during PTA in 131 consecutive patients who received heparin as the primary anticoagulant, and model the primary adverse event of salvage revascularization and any major complications.
Unfractionated heparin is the current antithrombotic of choice in peripheral vascular interventions. The rate of in-hospital major complications during peripheral angioplasty procedures (PTA) using heparin as the primary anticoagulant has not been well defined. In this single-center study, the charts of 213 consecutive PTA procedures in a 1-year period were reviewed. Of unstaged procedures, a total of 131 patients (57.3% males; mean age, 66.4 ± 12.1 years) met inclusion criteria. Forty-five patients (34.4%) had recent onset of claudication and 15 (11.5%) had ulceration. Thrombus was angiographically visualized in 16.7% of patients. Unfractionated heparin was administered at a mean of 4,672 ± 1,238 U (59.1 ± 20.0 U/kg) during the procedure. The highest activated clotting time (ACT) during the procedure was recorded in 114 patients. ACTs were < 300, 300-400 and > 400 seconds in 29.0%, 29.0% and 42.1%, respectively. In-hospital clinical events occurred in 12 patients (9.2%) who met any one of the following endpoints: death (0.8%), limb loss (1.5%), major bleeding (4.6%), emergent need for repeat revascularization of the same vessel (7.6%), embolic stroke (0.0%) and vascular complications (1.5%). The best model associated with salvage revascularization included cigarette smoking within the past year, recent onset of claudication and PTA treatment below the knee. Increased dosages of heparin (U/kg) were associated with a trend toward higher rates of complications. A significant number of patients have in-hospital major complications following PTA procedures using unfractionated heparin as the primary anticoagulant. Current ongoing registries are evaluating the feasibility of direct thrombin inhibitors bivalirudin instead of heparin as a primary anticoagulant during PTA.
Unfractionated heparin is the current antithrombotic of choice in peripheral vascular interventions. Heparin has an unpredictable anticoagulation response, is an indirect thrombin inhibitor, does not inhibit bound thrombin and activates platelets. A contemporary in-hospital complication rate following percutaneous transluminal peripheral angioplasty (PTA) has not been well defined with the use of unfractionated heparin as the initial primary anticoagulant. In-hospital complication rates following PTA have been reported in the literature; they range from 3.5% to as high as 32.7%.1-7 These studies differed in their inclusion and exclusion criteria, designs, and patient numbers and characteristics, and undertook no consistent reporting on anticoagulation regimen utilized. Given the continuous search for a better anticoagulant than heparin during percutaneous interventions, it is important to define our current baseline complication rate during PTA with heparin as the primary anticoagulant.
In this single-center experience, we report on our complication rate during PTA in 131 consecutive patients who received heparin as the primary anticoagulant, and model the primary adverse event of salvage revascularization and any major complications.
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