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CLINICAL STUDIES

Heparin after percutaneous intervention (HAPI): a prospective multicenter randomized trial of three heparin regimens after successful coronary intervention

Maher Rabah, DO^*, Denise Mason, BSN^*, David W. M. Muller, MD, FACC , Randal Hundley, MD, FACC, Aaron D. Kugelmass, MD, FACC^||, Bonnie Weiner, MD, FACC^¶, Louis Cannon, MD, FACC^¶, William W. O’Neill, MD, FACC^* and Robert D. Safian, MD, FACC^*

^* Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
Department of Cardiology, St. Vincent’s Hospital, Sydney, Australia
Department of Cardiology, Baptist Medical Center, Little Rock, Arkansas, USA
Department of Cardiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
^|| Department of Cardiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
^¶ Department of Cardiology, Saginaw, Michigan, USA

Manuscript received April 27, 1998; revised manuscript received March 6, 1999, accepted April 9, 1999.

Reprint requests and correspondence: Robert D. Safian, Director, Interventional Cardiology, Division of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073
rsafian{at}beaumont.edu

OBJECTIVES

The purpose of this study was to determine the incidence of bleeding, vascular, and ischemic complications using three different heparin regimens after successful intervention.

BACKGROUND

The ideal dose and duration of heparin infusion after successful coronary intervention is unknown.

METHODS

Patients were randomized to one of three heparin strategies after coronary intervention: Group 1 (n = 157 patients) received prolonged (12 to 24 h) heparin infusion followed by sheath removal; Group 2 (n = 120 patients) underwent early removal of sheaths, followed by reinstitution of heparin infusion for 12 to 18 h; Group 3 (n = 137 patients) did not receive any further heparin after intervention with early sheath removal. The primary end point of the study was the combined incidence of in-hospital bleeding and vascular events. Secondary end points included in-hospital ischemic events, length of stay, cost and one-month outcome.

RESULTS

After successful coronary intervention, 414 patients were randomized. Unstable angina or postinfarction angina was present in 83% of patients before intervention. The combined incidence of bleeding and vascular events was 21% in Group 1, 14% in Group 2 and 8% in Group 3 (p = 0.01). The overall incidence of in-hospital ischemic complications was 2.2%; there were no differences between groups. Length of hospital stay was shorter (p = 0.033) and adjusted hospital cost was lower (p < 0.001) for Group 3. At 30 days, the incidence of delayed cardiac and vascular events was similar for all three groups.

CONCLUSIONS

Heparin infusion after successful coronary intervention is associated with more minor bleeding and vascular injury, prolonged length of stay and increased cost. In-hospital and one-month ischemic events rarely occur after successful intervention, irrespective of heparin use. Routine postprocedure heparin is not recommended, even in patients who present with unstable ischemic syndromes.

Abbreviations and Acronyms   ACT = activated clotting time   AV = arteriovenous   CABG = coronary artery bypass graft surgery   CI = confidence interval   CK = creatinine kinase   ECG = electrocardiogram   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty

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