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Heparins crossover in percutaneous coronary interventions: a real issue with increasing rate of transradial procedures?

Sciahbasi, Alessandro; Rigattieri, Stefano; Calcagno, Simone; Mancone, Massimo; Pendenza, Gianluca; Cera, Maria; Danza, Aurora Ilaria; Di Russo, Cristian; Bruno, Pasqualina; Fedele, Silvio; Pugliese, Francesco Rocco; Sardella, Gennaro

Journal of Cardiovascular Medicine: July 2015 - Volume 16 - Issue 7 - p 507–511
doi: 10.2459/JCM.0000000000000201
Anticoagulation: Original articles

Aims Current guidelines give a class III recommendation to the intraprocedural use of unfractionated heparin (UFH) in patients pretreated with enoxaparin. The aim of our study was to evaluate bleeding complications in patients who underwent percutaneous coronary interventions (PCIs) performed using intraprocedural crossover of heparin therapy.

Methods We retrospectively evaluated all PCIs performed at two Italian hospitals since January 2011 to December 2013. After a propensity-matched analysis, patients were divided into two groups (with a ratio 1 : 2) according to intraprocedural crossover of heparins (from enoxaparin to UFH) (Group 1) or intraprocedural UFH alone (Group 2). The primary end-point was a haemoglobin drop of at least 3 g/dl within 48 h after the procedure.

Results During the 3 years analysed, 3224 patients underwent PCI, and after the propensity analysis, 309 patients were considered eligible for our study: 104 patients in Group 1 (69 ± 12 years, 78% men) and 205 patients in Group 2 (69 ± 13 years, 80% men, P = NS). There were no significant differences between the two groups for BMI, periprocedural use of antiplatelet therapy, baseline haemoglobin haematocrit or platelets levels. The primary end-point did not differ between the two groups (2.9% in Group 1 and 3.4% in Group 2, P = 0.550). Also, nadir of haematocrit or haemoglobin levels did not differ between the two groups. Finally, in hospital, major adverse cardio-cerebrovascular events did not differ between the two groups (1.9% in Group 1 and 3.9% in Group 2, P = 0.50).

Conclusion In this retrospective analysis of a large PCI database, the ‘heparins crossover’ during PCI was not associated with increased bleeding risk.

aDepartment of Interventional Cardiology, Sandro Pertini Hospital, ASL RMB

bDepartment of Cardiology, University La Sapienza

cEmergency Department, Sandro Pertini Hospital, ASL RMB, Rome, Italy

Correspondence to Alessandro Sciahbasi, Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RMB, 00168, Rome, Italy Tel: +39 06 41433871; fax: +39 06 41433481; e-mail:

Received 17 April, 2014

Revised 23 July, 2014

Accepted 25 July, 2014

© 2015 Italian Federation of Cardiology. All rights reserved.