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CLINICAL STUDIES

High dose heparin as pretreatment for primary angioplasty in acute myocardial infarction: the Heparin in Early Patency (HEAP) randomized trial

Aylee Liem, MD^*, Felix Zijlstra, MD^*, Jan Paul Ottervanger, MD^*, Jan C. A. Hoorntje, MD^*, Harry Suryapranata, MD, FACC^*, Menko-Jan de Boer, MD^* and Freek W. A. Verheugt, MD, FACC

^* Hospital De Weezenlanden, Zwolle, the Netherlands
University Hospital Nijmegen, Nijmegen, the Netherlands

Manuscript received March 24, 1999; revised manuscript received October 20, 1999, accepted November 15, 1999.

Reprint requests and correspondence: Dr. Felix Zijlstra, Department of Cardiology, Hospital De Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands.
v.derks{at}diagram-zwolle.nl

OBJECTIVES

In the Heparin in Early Patency (HEAP) pilot study a beneficial effect of high-dose heparin on early patency in acute myocardial infarction (MI) was observed in a matched-control study.

BACKGROUND

High dose bolus intravenous injection of heparin may achieve lysis of coronary thrombi and could enhance early patency of the infarct related vessel in patients with MI scheduled for primary angioplasty.

METHODS

Before primary angioplasty, 584 patients with MI entered an open randomized trial of high dose (300 IU/kg) or low dose (0 or 5,000 IU) heparin. Of the 584 patients, 299 were randomized to high dose and 285 patients to low dose heparin.

RESULTS

Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 was observed before primary angioplasty in 65 patients (22%) in the high dose group and 60 patients (21%) in the low dose heparin group (p > 0.1), whereas TIMI flow grade 3 was observed in 38 (13%) and 24 patients (9%), respectively (p = 0.11). There were no differences in the clinical end points between the two groups. There were no hemorraghic strokes, while 10% of the patients in the high dose group required blood transfusion versus 6% in the low dose/no heparin group (p = 0.07). No subsets of patients showed beneficial effects of high dose heparin, such as patients with longer delay between heparin administration and diagnostic angiogram or patients with short delay between symptom onset and admission.

CONCLUSIONS

There is no benefit of high dose bolus heparin on early patency compared with no or low dose heparin.

Abbreviations and Acronyms   HEAP = Heparin in Early Patency   LDH = lactate dehydrogenase   LVEF = left ventricular ejection fraction   MI = myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction

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