Document Detail


Is heparin needed for patients with an intra-aortic balloon pump?
MedLine Citation:
PMID:  22495506     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We addressed the question of whether or not the currently available evidence base supports heparinization in the context of a patient requiring cardiovascular support with an intra-aortic balloon pump (IABP). A best evidence topic was written according to a previously defined structured protocol. A literature search returned 443 papers, 3 of which were deemed relevant. Jiang et al. randomized 153 patients requiring IABP to heparin or no heparin, matched for age, sex and comorbidities. There was no significant difference in limb ischaemia; however, incidence of bleeding was significantly increased in the heparinized group (14.1 vs 2.4%). One cohort study compared two management strategies of IABP in which patients either received heparin universally or selectively with heparin only given for certain pre-defined indications. They reported increased bleeding with universal heparinization (39.2 vs 31.8%) but similar other complication rates. Another cohort study in which patients with IABP were initially treated with glycoprotein IIb/IIIa antagonists only, reported bleeding and ischaemia rates within accepted ranges for heparinized patients. The use of anticoagulation with IABP is intended to reduce the risk of thrombus, thromboembolus or limb ischaemia whilst generating an increased risk of bleeding as a side-effect. The aforementioned studies demonstrate that omitting or implementing a selective use strategy of heparinization during IABP counterpulsation can significantly decrease the incidence of bleeding without an increase in ischaemic events. One study also performed angiography prior to IABP insertion on some of their patients, selecting the less diseased side to insert the IABP. Current evidence on this topic is sparse, especially as relates to patients in the context of cardiothoracic surgery. Just one study specifically looked at surgical patients. However, the existing data suggest that it is safe to omit heparinization when using IABP counterpulsation. The decision to heparinize should be weighed in the context of other indications or contraindications rather than being an automatic response to the use of IABP.
Authors:
Philip H Pucher; Ian G Cummings; Alex R Shipolini; David J McCormack
Related Documents :
22005456 - Use of a segmental thermoexpandable metal alloy stent in the management of malignant ur...
22192766 - Subscapularis function after transosseous repair in shoulder arthroplasty: transosseous...
22146946 - Combination of dexamethasone and tropisetron before thyroidectomy to alleviate postoper...
21666506 - Management of idiopathic clubfoot in toddlers by ponseti's method.
21358396 - Renal effects of synthetic colloids and crystalloids in patients with severe sepsis: a ...
8751296 - Encephaloceles of the anterior cranial fossa.
Publication Detail:
Type:  Journal Article; Review     Date:  2012-04-11
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-22     Completed Date:  2012-10-29     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  136-9     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, The London Chest Hospital, London, UK.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anticoagulants / adverse effects,  therapeutic use*
Benchmarking
Evidence-Based Medicine
Female
Hemorrhage / chemically induced
Heparin / adverse effects,  therapeutic use*
Humans
Intra-Aortic Balloon Pumping* / adverse effects
Ischemia / etiology,  prevention & control*
Male
Middle Aged
Risk Assessment
Risk Factors
Thromboembolism / etiology,  prevention & control*
Thrombosis / etiology,  prevention & control*
Time Factors
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Interact Cardiovasc Thorac Surg. 2012 Jul;15(1):140   [PMID:  22723545 ]
Interact Cardiovasc Thorac Surg. 2012 Jul;15(1):139-40   [PMID:  22723544 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Blogging Through Cancer: Young Women's Persistent Problems Shared Online.
Next Document:  Outcomes and predictors of prolonged ventilation in patients undergoing elective coronary surgery.