Comparison of Safety between Different Kinds of Heparins in Patients Receiving Intra-Aortic Balloon Counterpulsation.

Abstract

BACKGROUND:

 The present study aimed to compare the effectiveness and safety of low molecular-weight-heparin (LMWH) and unfractionated heparin (UFH) in acute myocardial infarction (AMI) patients receiving intra-aortic balloon counterpulsation (IABP).

MATERIALS AND METHODS:

 We retrospectively analyzed a total of 344 patients receiving IABP for cardiogenic shock, severe heart failure, ventricular septal rupture, or mitral valve prolapse due to AMI. A total of 161 patients received UFH (a bolus injection 70 U/kg immediately after IABP, followed by infusion at a rate of 15 U/kg/hour and titration to for 50 to 70 seconds of activated partial thromboplastin time. A total of 183 patients received LMWH (subcutaneous injection of 1.0 mg/kg every 12 hours for 5 to 7 days and 1.0 mg/kg every 24 hours thereafter). Events of ischemia, arterial thrombosis or embolism, and bleeding during IABP were evaluated. Major bleeding was defined as a hemoglobin decrease by >50 g/L (vs. prior to IABP) or bleeding that caused hemodynamic shock or life-threatening or requiring blood transfusion.

RESULTS:

 Subjects receiving UFH and LMWH did not differ in baseline characteristics. Ischemia was noted in five (3.1%) and two (1.1%) subjects in UFH and LMWH groups, respectively. Arterial thromboembolism occurred in three (1.9%) subjects in the UFH group, but not in the LMWH group. Logistic regression analysis failed to reveal an association between ischemia or bleeding with heparin type. Major bleeding occurred in 16 (9.9%) and six (3.3%) patients in the UFH and LWMH groups, respectively (p = 0.014). Regression analysis indicated that LMWH is associated with less major bleeding.

CONCLUSION:

 LMWH could reduce the risk of major bleeding in patients receiving IABP. Whether LMWH could reduce arterial thromboembolism needs further investigation.

• Authors: Xiaonan Guan, Mulei Chen, Yanbing Li, Jianjun Zhang, Li Xu, Hao Sun, Dapeng Zhang, Lefeng Wang, Xinchun Yang
• Journal: The Thoracic and cardiovascular surgeon (Thorac Cardiovasc Surg) Vol. 69 Issue 6 Pg. 511-517 (Sep 2021) ISSN: 1439-1902 [Electronic] Germany
• PMID: 32998166 (Publication Type: Comparative Study, Journal Article)
• Copyright: The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Chemical References

• Anticoagulants
• Heparin, Low-Molecular-Weight
• Heparin

Topics

• Aged
• Anticoagulants (administration & dosage, adverse effects)
• Comparative Effectiveness Research
• Female
• Hemorrhage (chemically induced)
• Heparin (administration & dosage, adverse effects)
• Heparin, Low-Molecular-Weight (administration & dosage, adverse effects)
• Humans
• Intra-Aortic Balloon Pumping (adverse effects, mortality)
• Ischemia (diagnostic imaging, etiology, prevention & control)
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, mortality, physiopathology, therapy)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Thromboembolism (diagnostic imaging, etiology, prevention & control)
• Time Factors
• Treatment Outcome