Abstract 4590: Safety and Efficacy of Prolonged Use of Unfractionated Heparin After Percuatneous Coronary Intervention: A Meta-Analysis
The current guidelines for percutaneous coronary intervention (PCI) do not address the prolonged post-procedural use of unfractionated heparin (UFH) to prevent acute occlusion. However, recently published small studies have yielded mixed results, leaving the question unanswered. Hence a meta-analysis was performed to evaluate safety and efficacy of prolonged use of UFH after PCI. A systematic review of literature revealed 7 studies (Juergens et al, Rabah et al, Garachemani et al, Pizzulli et al, Freidman et al, Tanajura et al and Ellis et al) involving 2412 patients. End points analyzed were ischemic complications (acute closure, myocardial infarction and repeat revascularization) and major vascular complications (hematoma, arterio-venous fistula, pseudo-aneurysm and retroperitoneal bleed). Since the studies were homogenous for outcomes, combined relative risks (RR) across all the studies and the 95% confidence intervals were computed using the Mantel-Haenszel fixed-effect model. A two-sided alpha error < 0.05 was considered to be statistically significant. There were no significant differences in patient demographics between both groups. Compared with placebo the risk of major vascular complication was significantly higher in patients getting post-procedural UFH for prolonged hours (RR: 2.24, CI: 1.68 – 3.48; p=0.001). However, the risk of ischemic complications was similar in both groups (RR: 0.95, CI: 0.46 – 1.96; p=0.89). The meta-analysis suggests that prolonged use of UFH after PCI may result in increased major vascular complications, even though the incidence of ischemic complications may not decrease.