Journal of Zhejiang University-SCIENCE A

, Volume 4, Issue 5, pp 607–611 | Cite as

Anticoagulation therapy in intra-aortic balloon counterpulsation: Does IABP really need anti-coagulation?

  • Jiang Chen-yang
  • Zhao Li-li
  • Wang Jian-an
  • San Jiang
  • Mohammod Balgaith
Medicine

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.

Key words

Intra-aortic balloon pump Anti-coagulation Ischemia 

Document Code

CLC number

R540.4 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alderman, J. D., Gabliani, G. I. and McCabe, C. H., 1987. Inccidence and management of limb ischemia with percutaneous wire-guided intra-aortic balloon catheters.J Am Coll Cardiol,9: 524–530.CrossRefGoogle Scholar
  2. Cohen, M., Dawson, M. S., Kopistansky, C. and McBride, R., 2000. Sex and other predictors of intra-aortic balloon pump complication: prospective study of 1119 consecutive patients.Am Heart J,139: 282–287.Google Scholar
  3. Ferguson, J. J. 3rd., Cohen, M., Freedman, R. J. Jr., Stone, G. W., Miller, M. F., Joseph, D. L. and Okman, E. M., 2001. The current practice of intra-aortic balloon counterpulsation: Results from the Benchmark Registry.J Am Coll Cardiol,38(5): 1456–1462.CrossRefGoogle Scholar
  4. Funk, M., Gleason, J. and Foell, D., 1989. Lower limb ischemia related to use of the intra-aortic balloon pump.Heart Lung,18: 542–552.Google Scholar
  5. Iverson, L. I. G., Herfindahl, G. and Ecker, R. R., 1988. Vascular complications of intra-aortic balloon counter-pulsationAm J surg,123: 1207–1212.Google Scholar
  6. Kleiman, N. S., Lincoff, M., Flaker, G. S., Pieper, K. S., Wilcox, R. C., Berdan, L. G., Lorenz, T. J., Cokkinos, D. V., Somoons, M. and Boersma, E., 2000. Early, percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes.Circulation,101: 751–757.CrossRefGoogle Scholar
  7. Kuki, S., Taniguchi, K., Msai, T., Yoshida, K., Yamamoto, K. and Matsuda, H., 2001. Usefulness of the low profile “True 8” intra-aortic balloon pumping preventing limb ischemia.ASAIO J,47(6): 611–614.CrossRefGoogle Scholar
  8. Li, W. X. and Zhou, Q. W., 2001. Application of intra-aortic balloon counterpulsation in coronary artery disease surgery.K X Med Uni J,18(1): 42–44 (in Chinese).Google Scholar
  9. Matthew, T. R., 2000. Manual of cardiovascular medicine. Lippincott Williams & Wilkin, p. 687–699.Google Scholar
  10. Mueller, X. M., Tevaearai, H. T. and Von, S. K., 1999. Intra-aortic balloon: evaluation of heparin-coating under various experimental conditions.Int J Artif Organs,22 (9): 625–628.Google Scholar
  11. Ohley, W. J., Antonelli, L. and Leschinsky, B., 1998. Influence of catheter and arterial diameter on flow distal to an intra-aortic balloon insertion site: a theoretic examination and in vitro assessment.ASAIO J,44(6): 786–793.CrossRefGoogle Scholar
  12. Stavarski, D. H., 1996. Complications of intra-aortic balloon pumping. Preventable or not preventable?Cirt Care Nurs Clin North Am,8(4): 409–421.Google Scholar
  13. Steven, P. M., Brian, P. G. and Eric, J. T., 2000. Manual of cardiovascular medicine. Lippincoot, Williams & Wilkins, p. 687–699.Google Scholar
  14. Suzanne, J. F., Alfred, S., Ubeydullah, D., Scott, W. S., Anselmo, A. and Timothy, G., 1997. Hemastatic assessment of patients undergoing intra-aortic balloon pump therapy.J E Corpo Tech,29(2): 78–82.Google Scholar
  15. Sato, K., Tokairin, H. and Kato, M., 2001. Two patients treated with intra-aortic balloon pump counterpulsation for subarachnoid hemorrhage.Masue,50(8): 859–862.Google Scholar
  16. Winters, K. J., Smith, S. C., Cohen, M., Kopistansky, C. and McBride, R., 1999. Reduction in ischemic vascular complications and balloon leak with a hydrophilic-coated intra-aortic balloon catheter.Cathet Cardiovasc Intervent,46: 357–362.CrossRefGoogle Scholar

Copyright information

© Zhejiang University Press 2003

Authors and Affiliations

  • Jiang Chen-yang
    • 1
  • Zhao Li-li
    • 2
  • Wang Jian-an
    • 1
  • San Jiang
    • 1
  • Mohammod Balgaith
    • 3
  1. 1.Department of Cardiology, Sir Run Run Shaw HospitalZhejiang UniversityHangzhouChina
  2. 2.Department of Cardiology, First Affilicated HospitalZhejiang UniversityHangzhouChina
  3. 3.King Abdulaziz Cardiac CenterRiyadhSaudi Arabia

Personalised recommendations