Safety of Intra‐aortic Balloon Pump Using Glycoprotein IIb/IIIa Antagonists

Abstract

Background: Anticoagulation with heparin is recommended with intra-aortic balloon pump (IABP) to prevent thrombosis and embolization. However, anticoagulation increases the risk of bleeding, particularly in combination with glycoprotein (GP) IIb/IIIa antagonists. Hypothesis: We investigated the safety of using GP IIb/IIIa antagonists without heparin after IABP insertion in patients who underwent primary percutaneous coronary intervention (PCI). Methods: Consecutive patients with acute myocardial infarction (AMI), who underwent primary PCI and were treated with GP IIb/IIIa antagonists without concomitant heparin, and in whom IABP was inserted, were followed during hospitalization for thrombotic and hemorrhagic complications. Results: Ninety-seven patients were included in this analysis. Glycoprotein IIb/IIIa antagonist treatment duration was 12-24 h in 89% of patients, and IABP duration was up to 48 h in 97% of patients. Three patients (3.1%) developed vascular complications: 1 had a major limb ischemia (long IABP treatment), 1 had a minor limb ischemia, and 1 had a cerebrovascular event (after prolonged resuscitation). All patients were already on heparin at the time of the thrombotic events. The rates of major and minor bleeding complications were 9% and 15.5%, respectively. Conclusions: The rate of thrombotic complications is relatively low in post-primary PCI patients with IABP treated with GP IIb/IIIa antagonists without concomitant heparin therapy. Such an approach may reduce the risk of hemorrhagic complications, with low risk of thrombotic complications.Key words: intra-aortic balloon pump, myocardial infarction, glycoprotein IIb/IIIa antagonists, complications IntroductionAlthough anticoagulation with heparin is recommended during intra-aortic balloon pump (IABP) to prevent catheterrelated thrombosis and embolization, 1 no data or guidelines exist to support this strategy. 2 In fact, 1 study that randomly assigned 153 patients to receive heparin (or no heparin) during IABP found no difference in the incidence of limb ischemia. 3 Moreover, with advanced technology, the IABP catheter has a lower profile and the incidence of limb ischemia has decreased. 4 The incidence of major limb ischemia in IABP patients treated with heparin alone is 0.9%, 5,6 reaching 10.3% in post-operative patients, 7 while the incidence of minor limb ischemia in IABP patients treated with heparin alone is as high as 4.2%.

Heparin-free Management of Intra-aortic Balloon Pump after Cardiac Surgery

“…In our study the rate of ischemic complications was 2.6% and the rate of minor bleeding complications was 4.2%. These findings are in accord with the complication rates of previous studies 5–11 . There was no difference concerning vascular complications in Group I (<24 hours following surgery) and Group II (>24 hours following surgery).…”

“…While they found no differences in ischemic complications, bleeding from the puncture site was more common in the heparin‐treated patients. Laish‐Farkash et al 10 reported a 3.1% rate of ischemic complications and a 9% rate of major bleeding complications in patients following primary percutaneous coronary intervention treated with both aspirin and glycoprotein IIb/IIIa antagonists without heparin. However, Chin et al 11 compared patients from the Benchmark Counterpulsation Outcomes Registry who received and did not receive anticoagulation therapy during IABP, and reported that anticoagulation was associated with a lower mortality rate (18.2% vs. 15.5%, respectively) and less limb ischemia (3.2% vs. 2.4%, respectively).…”

Clinical Implications of Thrombocytopenia Among Patients Undergoing Intra‐aortic Balloon Pump Counterpulsation in the Coronary Care Unit

“…1,10 As in the study by Bream-Rouwenhorst et al, we found that the degree of platelet count reduction was greater among patients with HIT than among those without HIT. 1 Because of the important clinical implications of this diagnosis, this finding suggests that IABP patients who are receiving heparin and who have a marked reduction in platelet count (>50%) should be considered for HIT testing.…”

Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock

“…After applying inclusion and exclusion criteria, 16 articles remained eligible for meta-analysis, of which 13 were prospective studies and 3 were retrospective studies. [13][14][15][16][17][18][19][20][22][23][24][25][26][27][28][29] Eight studies were excluded because no control arm was available, 30 no mortality data were available, [31][32][33][34] or there was different timing of outcomes. [35][36][37] Thus, the systematic literature search for studies comparing the effects of IABP with no IABP in patients with AMI, with or without cardiogenic shock using aforementioned criteria revealed a total of 16 studies (N ¼ 11 778).…”