Anticoagulation therapy in intra-aortic balloon counterpulsation: Does IABP really need anti-coagulation? |
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| Authors: | Jiang Chen-yang Zhao Li-li Wang Jian-an San Jiang Mohammod Balgaith |
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| Institution: | (1) Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University, 310016 Hangzhou, China;(2) Department of Cardiology, First Affilicated Hospital, Zhejiang University, 310006 Hangzhou, China;(3) King Abdulaziz Cardiac Center, Riyadh, Kindom of Saudi Arabia |
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| Abstract: | Objective: To investigate if intra-aortic balloon pump(IABP) is contraindicated without anticoagulation therapy. Methods:
Some 153 IABP patients in the King Abdulaziz Cardiac Center(KSA) were randomly assigned into two groups. Anticoagulation group
(Group A) consisted of 71 patients who were given heparin intravenously with target aPTT50–70 seconds. Non-anticoagulation
group (Group B) consisted of 82 patients without intravenous heparin during balloon pumping. Hematological parameters including
platelet count, D-dimer, Plasminogen activator inhibitor-1 (PAI-1) and fibrinogen degradation products (FDP) were checked
respectively at the point of baseline, 24 hours, 48 hours and 24 hours post IABP counterpulsation. Clot deposits on balloon
surface, vascular complications from IABP including bleeding and limb ischemia were recorded. Results: Platelet count and
PAI-1 level decreased at 24 hours and 48 hours in both groups (P<0.05). D-dimer dimer and FDP level increased at 24 hours and 48 hours in both groups(P<0.05), but returned to the baseline level 24 hours post IABP removal (P>0.05). Three patients in Group A and 2 patients in Group B developed minor limb ischemia (P>0.05). No major limb ischemia in either group. Two patients in Group A suffered major bleeding and required blood transfusion
or surgical intervention, whereas no patient had major bleeding in Group B. Eight patients had minor bleeding in Group A,
but only 2 patients in Group B (P<0.05). No clot deposit developed on IABP surface in either group. Conclusion: IABP is safe without routine anticoagulation
therapy. Selecting appropriate artery approach and early detection intervention are key methods for preventing complications. |
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| Keywords: | Intra-aortic balloon pump Anti-coagulation Ischemia |
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