Abstract
BACKGROUND: The benefits of intracoronary stent implantation are offset by an increased risk of complications at the arterial puncture site and a prolonged hospital stay. Much of this morbidity can be attributed to the generally perceived need to achieve systemic anticoagulation after stent implantation. AIM: To test a simplified protocol for post-stent management using the Femostop pneumatic groin compression device and low molecular weight (fractionated) heparin (LMWH) administered by subcutaneous injection. PATIENTS: A case series of 100 consecutive patients, with stable angina pectoris, undergoing coronary stenting for a suboptimal result after conventional balloon angioplasty. METHODS: All patients were managed with a new post-stent protocol using the Femostop pneumatic groin compression device and LMWH. The incidence of complications and the length of hospital stay were recorded. RESULTS: The clinical course was uncomplicated in 92 patients and their discharge from hospital was achieved on the first post-procedural day for 44 patients and on the second for the remaining 48. The rate of vascular or bleeding complications was 6%. CONCLUSIONS: LMWH administered by subcutaneous injection may provide a practical and effective alternative to the use of intravenous heparin when systemic anticoagulation is used after stent implantation.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Cziraky M. J., Spinler S. A. Low-molecular-weight heparins for the treatment of deep-vein thrombosis. Clin Pharm. 1993 Dec;12(12):892–899. [PubMed] [Google Scholar]
- Fischman D. L., Leon M. B., Baim D. S., Schatz R. A., Savage M. P., Penn I., Detre K., Veltri L., Ricci D., Nobuyoshi M. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994 Aug 25;331(8):496–501. doi: 10.1056/NEJM199408253310802. [DOI] [PubMed] [Google Scholar]
- Hirsh J. Rationale for development of low-molecular-weight heparins and their clinical potential in the prevention of postoperative venous thrombosis. Am J Surg. 1991 Apr;161(4):512–518. doi: 10.1016/0002-9610(91)91123-z. [DOI] [PubMed] [Google Scholar]
- Hull R. D., Pineo G. F. Low molecular weight heparin treatment of venous thromboembolism. Prog Cardiovasc Dis. 1994 Sep-Oct;37(2):71–78. doi: 10.1016/s0033-0620(05)80043-x. [DOI] [PubMed] [Google Scholar]
- Jørgensen L. N., Wille-Jørgensen P., Hauch O. Prophylaxis of postoperative thromboembolism with low molecular weight heparins. Br J Surg. 1993 Jun;80(6):689–704. doi: 10.1002/bjs.1800800607. [DOI] [PubMed] [Google Scholar]
- Samama M. M., Bara L., Gerotziafas G. T. Mechanisms for the antithrombotic activity in man of low molecular weight heparins (LMWHs). Haemostasis. 1994 Mar-Apr;24(2):105–117. doi: 10.1159/000217090. [DOI] [PubMed] [Google Scholar]
- Serruys P. W., de Jaegere P., Kiemeneij F., Macaya C., Rutsch W., Heyndrickx G., Emanuelsson H., Marco J., Legrand V., Materne P. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994 Aug 25;331(8):489–495. doi: 10.1056/NEJM199408253310801. [DOI] [PubMed] [Google Scholar]
- Warkentin T. E., Levine M. N., Hirsh J., Horsewood P., Roberts R. S., Gent M., Kelton J. G. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med. 1995 May 18;332(20):1330–1335. doi: 10.1056/NEJM199505183322003. [DOI] [PubMed] [Google Scholar]
- Wolf H. Low-molecular-weight heparin. Med Clin North Am. 1994 May;78(3):733–743. doi: 10.1016/s0025-7125(16)30155-9. [DOI] [PubMed] [Google Scholar]