PMID- 31075466
OWN - NLM
STAT- MEDLINE
DCOM- 20191223
LR  - 20191223
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 60
DP  - 2019 Oct
TI  - Anticoagulant Effect of Standard Dose Heparin During Peripheral Endovascular 
      Intervention.
PG  - 286-292
LID - S0890-5096(19)30288-2 [pii]
LID - 10.1016/j.avsg.2019.02.033 [doi]
AB  - BACKGROUND: The objective of this clinical study was to investigate the 
      anticoagulant effect of standard fixed dose of heparin during endovascular 
      intervention in the lower extremity arteries. METHODS: A prospective clinical 
      pilot study was completed with retrospective quality review of patients between 
      2015 and 2017 (n = 61). Patients undergoing elective endovascular intervention 
      for arterial insufficiency in the lower extremities were enrolled. A standard 
      fixed intra-arterial dose of 5000 IU of unfractionated heparin (UFH) was 
      administered during the procedure without adjustment for weight or monitoring. 
      Activated clotting time (ACT) was measured before and ten minutes after heparin 
      administration and at the end of the procedure. The primary study end point was 
      the level of heparin anticoagulation after standard perioperative administration. 
      RESULTS: Mean age was 74 +/- 9 years, 48% women. Mean weight was 74 +/- 15 kg, and 
      mean BMI, 25.6 +/- 4.7 kg/m(2). The endovascular interventions were performed at 
      the iliac arteries 19.7% (12/61), at the femoral popliteal segment 50.8 % 
      (31/61), below the knee arteries 6.6% (4/61), and at multiple levels 13% (8/61). 
      The perioperative mean ACT increased from baseline 155 +/- 43 s (n = 31) to ten 
      minutes after heparin administration 290 +/- 70 s (n = 60) (P < 0.01) and was at 
      the end of the procedure 276 +/- 73 s (n = 59). Perioperative ACT ten minutes after 
      heparin administration: 5.0% (3/60) of the patients had ACT <200 s, 25.0% (15/60) 
      had ACT 200-250 s, 48.3% (29/60) ACT 251-349, and 21.7% (13/60) ACT >/=350 s. At 
      the end of the procedure, 17.2 % (10/58) of the patients had ACT <200, 24.1 % 
      (14/58) had ACT 200-250 s, 37.9% (22/58) ACT 251-349, and 20.7 % (12/58) ACT 
      >/=350 s. The mean dose of heparin per kg body weight was 70 +/- 15 IU/kg. There was 
      a significant difference between the ACT groups when analyzing heparin dose per 
      kg body weight: 54 +/- 14 IU/kg for patients with ACT <200, 69 +/- 13 IU/kg with ACT 
      200-250 s, 68 +/- 13 IU/kg with ACT 251-349, and 81 +/- 18 IU/kg with ACT >350 
      (P = 0.0095). The same pattern was seen for heparin dose per BMI and DuBois. In 
      univariate logistic regression analysis, ACT >/=350 s was associated with lower 
      body weight (OR 0.92; 95% CI 0.87-0.98; P = 0.008), lower BMI (OR 0.80; 95% CI 
      0.67-0.96; P = 0.014), and lower body surface area DuBois (OR 0.53; 95% 
      0.32-0.85; P = 0.009). In multivariable regression, the ACT association with body 
      weight remained (OR 0.92; 95% 0.87-0.98; P = 0.008). There were no perioperative 
      or immediate postoperative bleeding complications requiring blood transfusion or 
      surgical intervention in this study cohort. CONCLUSIONS: The standard heparin 
      dosing of 5000 IU during endovascular intervention for arterial insufficiency in 
      the lower extremities helps achieve ACT >200 s in almost all patients, but most 
      patients were outside recommended target interval. To provide a more consistent 
      and predictable heparinization, a weight-based bolus dose of 70 IU heparin/kg is 
      recommended.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Nissborg, Emelie
AU  - Nissborg E
AD  - Department of Vascular Surgery, Karolinska Institutet and Karolinska University 
      Hospital, Stockholm, Sweden.
FAU - Wahlgren, Carl-Magnus
AU  - Wahlgren CM
AD  - Department of Vascular Surgery, Karolinska Institutet and Karolinska University 
      Hospital, Stockholm, Sweden. Electronic address: carl.wahlgren@sll.se.
LA  - eng
PT  - Clinical Study
PT  - Journal Article
DEP - 20190507
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Blood Coagulation/*drug effects
MH  - Drug Monitoring/methods
MH  - *Endovascular Procedures/adverse effects
MH  - Female
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Lower Extremity/*blood supply
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/blood/diagnosis/*therapy
MH  - Pilot Projects
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - Whole Blood Coagulation Time
EDAT- 2019/05/11 06:00
MHDA- 2019/12/24 06:00
CRDT- 2019/05/11 06:00
PHST- 2018/11/17 00:00 [received]
PHST- 2019/02/18 00:00 [revised]
PHST- 2019/02/19 00:00 [accepted]
PHST- 2019/05/11 06:00 [pubmed]
PHST- 2019/12/24 06:00 [medline]
PHST- 2019/05/11 06:00 [entrez]
AID - S0890-5096(19)30288-2 [pii]
AID - 10.1016/j.avsg.2019.02.033 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2019 Oct;60:286-292. doi: 10.1016/j.avsg.2019.02.033. Epub 2019 
      May 7.