Abstract 10175: The Impact of Anticoagulation During Intra-Aortic Balloon Counterpulsation Pump Placement on In-Hospital Outcomes in 18,875 Patients Undergoing Cardiac Revascularization
Background: Anticoagulation during intra aortic balloon counterpulsation pumping (IABP) is widely considered standard adjunctive therapy to prevent catheter thrombosis and embolic events. However, there is a paucity of data to support this recommendation and no formal guidelines exist.
Methods: A total of 18,875 patients underwent coronary revascularization from 1996 through 2004 in the Benchmark Counterpulsation Outcomes Registry. Baseline patient characteristics and observed in-hospital mortality and complication rates were compared between patients who received (AC group) and did not receive (no-AC group) anticoagulation during IABP. Using a multivariable logistic regression model, we tested factors (including anticoagulation) for their association with any major complication of IABP usage (death due to IABP, major limb ischemia, severe bleeding, or balloon leak).
Results: The mean age was 66 years and 31.1%; were female. Patient characteristics and in-hospital outcomes are shown in the Table. In the AC group, as compared with the no-AC group, observed in-hospital mortality and limb ischemia rates were lower . No significant difference in bleeding rates was seen.
Factors independently associated with a major IABP complication were body surface area <1.65m2[Odds Ratio (O.R) = 2.5], being female (O.R = 2.4), peripheral arterial disease (O.R = 2.2), and age >75 yrs (O.R = 1.6), all p <0.0001. Anticoagulation use was associated with a trend for a lower risk of developing any major IABP complication (O.R = 0.9, p = 0.08), after adjustment.
Conclusion: In this large observational study of anticoagulation during IABP support, our findings suggest that anticoagulation was associated with favorable clinical outcomes (fewer in-hospital deaths and less limb ischemia), without increasing bleeding risk. Where possible, anticoagulation should be considered for all IABP patients.
- © 2010 by American Heart Association, Inc.