A randomized trial of a fixed high dose vs a weight-adjusted low dose of intravenous heparin during coronary angioplasty

Aims Prospectively to compare success rate and complications in percutaneous transluminal coronary angioplasty using two doses of heparin. Methods and results Four hundred patients undergoing coronary angioplasty were randomly assigned to receive 15 000 IU (group A) or 100 IU. kg −1 (group B) of heparin. The angioplasty success rate was 95% in both groups. Stents were placed in 28·5% and 26·5% of patients in groups A and B, respectively ( P =0·73). The primary endpoint (freedom from death, myocardial infarction, unplanned revascularization or bailout stenting) occurred in 91% vs 95% of patients in groups A and B, respectively (odds ratio: 1·88, 95% CI: 0·80—4·50, P =0·12). Haemoglobin loss was 0·36 ± 1 and 0·27 ± 0·9 g. dl −1 in groups A and B, respectively ( P =0·37). The time to sheath removal (735 ± 265 vs 558 ± 246 min) and the time to transfer to a stepdown unit (12·7 ± 4·5 vs 9·8 ± 4·2 h) were longer in groups A ( P =0·0001 for both comparisons). Conclusion A weight-adjusted low dose of intravenous heparin is at least as safe as a fixed high dose for coronary angioplasty. It allows earlier sheath removal and discharge to a stepdown unit.