The Use of Heparin during Endovascular Peripheral Arterial Interventions: A Synopsis

Wiersema, Arno M.; Durran, A.; Reijnen, Michel M.P.J.; Delden, Otto M. van; Moll, Frans L.; Vos, Jan Albert

doi:10.1155/2016/1456298

Cited by 12 publications

(12 citation statements)

References 46 publications

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“…In addition, intravenous administration of heparin should have been performed when the guiding sheath was inserted via the left brachial artery [6]. Heparin is used as a periprocedural prophylactic antithrombotic agent to prevent distal and proximal arterial thromboembolic complications, reduce the formation of thrombi on catheters, and prevent the formation of blood clots within catheters [7]. A continuous heparin flush is considered necessary whenever there is any space between the sheath and the catheter [8].…”

Section: Discussionmentioning

confidence: 99%

Thromboaspiration for Iatrogenic Thrombotic Occlusion of the Superior Mesenteric Artery during Endovascular Treatment of Pancreaticoduodenal Artery Aneurysm and Celiac Artery Occlusion

Sakugawa

Ishigami

Nakamata

et al. 2020

Interventional Radiology

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Herein, we present a case of superior mesenteric artery (SMA) thrombus as a complication of stent placement for celiac stenosis and coil packing of a pancreaticoduodenal artery aneurysm. The SMA thrombus was likely caused by thromboembolism from the guiding sheath in the SMA without a continuous heparin flush. It was promptly treated with aspiration thrombectomy, and there was no mesenteric ischemia. To avoid thromboembolic complications, periprocedural prophylactic antithrombotic therapy should also have been performed because a complex procedure involving the pull-through technique was performed.

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Section: Discussionmentioning

confidence: 99%

Thromboaspiration for Iatrogenic Thrombotic Occlusion of the Superior Mesenteric Artery during Endovascular Treatment of Pancreaticoduodenal Artery Aneurysm and Celiac Artery Occlusion

Sakugawa

Ishigami

Nakamata

et al. 2020

Interventional Radiology

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“…Ennek eszköze a jellemzően bolus formájában adott heparin. A katéterek átöblítésére, a vezetődrótok előkészítésére heparinizált sóoldatot alkalmaznak [38].…”

Section: A Periprocedurális Gyógyszeres Kezelés Szempontjaiunclassified

Az alsó végtagi endovascularis verőér-beavatkozások során alkalmazott antithromboticus, antikoaguláns terápia szempontjai

Szabó

Dósa

Csobay-Novák

et al. 2022

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Összefoglaló. A népesség öregedése, a meghatározó cardiovascularis rizikótényezők – mint a cukorbetegség – egyre nagyobb arányú előfordulása, a csökkenő akut cardiovascularis halálozás az alsó végtagi verőérszűkület növekvő megjelenésével jár. Ezzel együtt szaporodnak a beavatkozást igénylő, jelentős életminőség-romlást, illetve végtag-veszélyeztetettséget okozó, súlyosabb esetek. Ilyenkor az alsó végtagi revascularisatio szüksége merül fel, ami az utóbbi évtizedben az endovascularis beavatkozások számának növekedéséhez vezetett. A beavatkozások technikai sikere mellett újabb szűkületek, elzáródások veszélyével kell számolni. Ennek hátterében az atherosclerosis progressziója mellett a beavatkozáshoz köthető, kontrollált érfalsérülés indukálta vascularis remodelling (neointima-hyperplasia), valamint thromboticus tényezők állnak. Az ér-nyitvamaradás hosszú távú biztosításának feltétele a fenti folyamatok megelőzésére alkalmazott optimális gyógyszeres kezelés. Ennek biztosítása elengedhetetlen a beavatkozást megelőzően, periprocedurálisan, majd az érintett betegkör hosszú távú gondozása során. A gyógyszeres terápiás lehetőségek közül az antithromboticus, antikoaguláns terápiának kiemelt jelentősége van. Az ezen hatású gyógyszerek alkalmazását igen nehézzé teszi (i) a thromboticus elzáródás kiújulása és a potenciális vérzés közötti dinamikusan változó egyensúly bizonytalansága, (ii) az egyéb társbetegségek kapcsán felmerülő terápiás szempontok egyidejű érvényesítése, valamint (iii) a napi ellátásban támpontot adó tudományos bizonyítékok relatív hiánya. Az összefoglaló tanulmány a fenti gyógyszerterápiás terület legújabb eredményeit kísérli meg elemezni. Orv Hetil. 2022; 163(3): 98–108. Summary. The aging of the population, the increasing prevalence of important risk factors of atherosclerosis, like diabetes, and the declining mortality of acute cardiovascular conditions lead to increased peripheral arterial disease incidence. At the same time, cases showing a severe decline in quality of life or danger of limb loss get more prevalent that demands vascular interventions. In such cases, revascularization is recommended, and consequently, in the last decade, an expansion in endovascular procedures can be seen. Considering these procedures, besides a technical success, the risk of new stenosis or occlusion may be imminent. This may be accounted for the progression of atherosclerosis and the controlled vascular injury caused by the procedure itself that induces vascular remodeling (neointima hyperplasia) and thrombotic hyperactivity. The long-term vascular patency is closely associated with the success of an optimal medical treatment strategy. Its effect is considered essential prior to the endovascular procedure, perioperatively, and in the phase of long-term follow-up of the affected patients. In this scenario, antithrombotic and anticoagulant therapy regimes bear particular relevance. The use of this kind of drugs is challenged by (i) the uncertainty of dynamic changes of balance between the thrombotic reocclusion and the risk of bleeding, (ii) the interplay of treatment strategy related to concomitant diseases, (iii) the relative lack of high-level scientific pieces of evidence guiding daily routine. The narrative review makes an effort to provide new findings and an analysis of this therapeutic field. Orv Hetil. 2022; 163(3): 98–108.

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“…Although heparin is the predominant peri-procedural antithrombotic agent used during NCAP, the optimal dose for this indication has not been established. 1,2,5 Multiple surveys 6e8 have demonstrated that almost all vascular surgeons and interventional radiologists worldwide use heparin, mostly by administering a single bolus of 5000 IU, although currently in the United States a weight dependent dose is more often preferred. 9 Although there is a lack of data on activated clotting time (ACT) for NCAP, there are reasonable quality data on the utility of ACT during percutaneous coronary intervention (PCI) and cardiac interventions.…”

Section: Introductionmentioning

confidence: 99%

No Concluding Evidence on Optimal Activated Clotting Time for Non-cardiac Arterial Procedures

Doganer

Wiersema

Scholtes

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Despite a striking lack of evidence on any beneficial effects, heparin has been used worldwide as a prophylactic antithrombotic for 70 years during all non-cardiac arterial procedures (NCAP). The optimal activated clotting time (ACT) and corresponding heparin dose in NCAP is currently unknown. This systematic review sought to assess the optimal level of ACT during NCAP, related to complication rate, and clinically relevant and patient related outcomes. The results show a lack of robust data on optimal target ACT during NCAP. Objectives: Heparin has a non-predictable effect in the individual patient. The activated clotting time (ACT) is used to measure the level of anticoagulation after administration of heparin. To date, appropriate heparin dose protocols and corresponding therapeutic ACT values have not been established in non-cardiac arterial procedures (NCAP). The aim of this review was to study the use of ACT monitoring during NCAP, and whether an optimal ACT could be determined based on the fewest arterial thrombo-embolic complications (ATEC) and bleeding complications. Methods: This systematic review was performed in accordance with the PRISMA Guidelines. A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane database. Any associations were evaluated between periprocedural ACT levels and ATEC and bleeding complications detected during the same admission as the primary procedure or during 30 day follow up. Also, heparin dose protocols, peri-procedural target ACTs, different ACT devices, protamine use and pre-, peri-, and post-procedural anticoagulation therapy were evaluated. Results: In total, 21 studies with 3982 patients were included, on both open and endovascular NCAP. Four studies were primarily designed to correlate peak peri-procedural ACT with clinical outcomes; however, the definitions of the results and the clinical outcomes were too heterogeneous for analysis. There was major variability in all studied aspects of ACT measurement, heparin and protamine use, and in the type of procedures in the included studies. Overall methodological quality of the included studies was poor. No randomised controlled trials were found. Studies were at a high risk of bias. Conclusions: This systematic review demonstrates a lack of data and no consensus in the literature concerning the optimal ACT, and the possible association with haemorrhagic complications and ATEC during NCAP.

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The Use of Heparin during Endovascular Peripheral Arterial Interventions: A Synopsis

Cited by 12 publications

References 46 publications

Thromboaspiration for Iatrogenic Thrombotic Occlusion of the Superior Mesenteric Artery during Endovascular Treatment of Pancreaticoduodenal Artery Aneurysm and Celiac Artery Occlusion

Thromboaspiration for Iatrogenic Thrombotic Occlusion of the Superior Mesenteric Artery during Endovascular Treatment of Pancreaticoduodenal Artery Aneurysm and Celiac Artery Occlusion

Az alsó végtagi endovascularis verőér-beavatkozások során alkalmazott antithromboticus, antikoaguláns terápia szempontjai

No Concluding Evidence on Optimal Activated Clotting Time for Non-cardiac Arterial Procedures

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