Unfractionated Heparin Therapy During Elective Percutaneous Coronary Intervention
DOI:
https://doi.org/10.11594/jk-risk.04.3.6Keywords:
Coronary artery disease; percutaneous coronary intervention, unfractionated heparinAbstract
Coronary artery Disease (CAD) occurs due to an imbalance between myocardial oxygen demand and supply due to total or partial blockage of the coronary artery. Occlusion of coronary artery blood vessels in CAD patients requires revascularization to restore blood flow and myocardial perfusion. One of the mechanical revascularization efforts is to perform a percutaneous coronary intervention (PCI) procedure. This technique involves the use of a guided catheter directed to the location of the coronary artery blockage, followed by balloon dilation and stent placement to maintain patency. Blood vessel injury during PCI exposes serine proteases to tissue factor and collagen, stimulating procoagulants that will activate the coagulation cascade. In CAD patients undergoing PCI therapy, periprocedural pharmacotherapy is given in the form of antiplatelet therapy accompanied by intravenous anticoagulants such as unfractionated heparin. Unfractionated heparin produces its main anticoagulant effect by inactivating thrombin and activating factor X (factor Xa) through a mechanism dependent on antithrombin (AT). Intravenous administration of unfractionated heparin in addition to producing anticoagulant effects can also increase the risk of bleeding. In order for the drug to effectively prevent clotting and not cause bleeding, it is necessary to determine the right dose. In connection with this, it is necessary to monitor hemostasis function with optimal Activated Clotting Time (ACT) values to prevent the risk of thrombosis and bleeding in patients undergoing PCI.
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References
Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Heart Disease and Stroke Statistics-2022 Update: A Report from the American Heart Association. Vol. 145, Circulation. Lippincott Williams and Wilkins; 2022. p. E153–639.
Badan Penelitian dan Pengembangan Kesehatan Kementerian RI. Riset Kesehatan Dasar (Riskesdas). 2018;
Perhimpunan dokter spesialis kardiovaskular indonesia. Pedoman tatalaksana sindrom koroner akut edisi ketiga. 2015.
Soleimannejad M, Aslanabadi N, Sohrabi B, Shamshirgaran M, Separham A, Kazemi B, et al. Activated clotting time level with weight based heparin dosing during percutaneous coronary intervention and its determinant factors. J Cardiovasc Thorac Res [Internet]. 2014;6(2):97–100. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25031824
Bowers J, Ferguson J. The Use of Activated Clotting Times to Monitor Heparin Therapy during and after Interventional Procedures. 1994; DOI: https://doi.org/10.1002/clc.4960170704
Shahjehan, Rai Dilawar, and Beenish S. Bhutta. "Coronary artery disease." (2020).
Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). European heart journal. 2020 Jan 14;41(3):407-77..
Candell-Riera J, Martín-Comín J, Escaned J, Peteiro J. Physiologic evaluation of coronary circulation. Role of invasive and noninvasive techniques. Revista Espanola de Cardiologia. 2002 Mar 1;55(3):271-91. DOI: https://doi.org/10.1016/S0300-8932(02)76596-2
Ahmad M, Mehta P, Reddivari AK, Mungee S. Percutaneous coronary intervention. 2020
Stouffer G, Todd JW, Yadav PK, Yousuf MA. Percutaneous coronary intervention. Retrieved September. 2012;18:2016.
Tarantino C. Coagulation Cascade: What is it, steps, and more.
Chaudhry R, Usama SM, Babiker HM. Physiology, coagulation pathways.
Palta S, Saroa R, Palta A. Overview of the coagulation system. Indian journal of anaesthesia. 2014 Sep 1;58(5):515-23. DOI: https://doi.org/10.4103/0019-5049.144643
Hirsh J, Anand SS, Halperin JL, Fuster V. Guide to anticoagulant therapy: Heparin: a statement for healthcare professionals from the American Heart Association. Circulation. 2001 Jun 19;103(24):2994-3018. DOI: https://doi.org/10.1161/01.CIR.103.24.2994
Lee MS, Kong J. Heparin: Physiology, Pharmacology, and Clinical Application. Reviews in cardiovascular medicine. 2015 Oct 1;16(3). DOI: https://doi.org/10.3909/ricm0778
Stouffer GA, Hirmerova J, Moll S, Rubery B, Napoli M, Ohman EM, Simpson R. Percutaneous coronary intervention in a patient with immune thrombocytopenia purpura. Catheterization and cardiovascular interventions. 2004 Mar;61(3):364-7. DOI: https://doi.org/10.1002/ccd.10799
Niccoli G, Banning AP. Heparin dose during percutaneous coronary intervention: how low dare we go?. Heart. 2002 Oct 1;88(4):331-4. DOI: https://doi.org/10.1136/heart.88.4.331
ten Berg JM, Plokker HT, Verheugt FW. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention. Trials. 2001 Jun;2:1-2. DOI: https://doi.org/10.1186/cvm-2-3-129
Garcia DA, Baglin TP, Weitz JI, Samama MM. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e24S-e43S. doi: 10.1378/chest.11-2291. Erratum in: Chest. 2012 May;141(5):1369. DOI: https://doi.org/10.1378/chest.11-2291
FUTURA/OASIS-8 trial group. Low-dose vs standard-dose unfractionated heparin for percutaneous coronary intervention in acute coronary syndromes treated with fondaparinux: the FUTURA/OASIS-8 randomized trial. JAMA-Journal of the American Medical Association. 2010 Sep 22;304(12):1339-49 DOI: https://doi.org/10.1001/jama.2010.1320
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