April 13, 2011 (New Orleans, Louisiana) — A low dose of heparin (50 IU/kg) seems to be sufficient for use in PCI if aspirin and clopidogrel are on board, according to the results of the DEDICA study.

The study was reported by Dr Vincenzo Pasceri (Campus Bio-medico University of Rome, Italy) at last week's American College of Cardiology 2011 Scientific Sessions.

Pasceri explained that current guidelines still recommend a standard dose of heparin (100 IU/kg) during coronary interventions and that this dose has been used as a gold standard in trials comparing heparin with new anticoagulants, but it is unclear whether this dose is still necessary when patients are pretreated with aspirin and clopidogrel.

To investigate the use of lower doses of heparin, Pasceri and colleagues designed a randomized, single-blind trial comparing the standard 100-IU/kg dose of heparin, with a target activating clotting time (ACT) >300 seconds, with a low dose (50 IU/kg), with a target ACT >180 seconds, in 713 consecutive patients undergoing coronary intervention. The study included both stable and unstable patients. Treatment with other anticoagulants or GP IIb/IIIa antagonists was excluded. Radial access was used in 62% of cases in both groups.

Results showed that at 30 days of follow-up, patients receiving low-dose heparin had a similar incidence of cardiac events, with a trend toward a reduction in bleeding. However, Pasceri noted that bleeding was low in both groups, probably due to the high use of radial access.

DEDICA: 30-Day Results

Outcome Heparin 100 IU/kg Heparin 50 IU/kg
Peak ACT (s) 318 196
MACE (%) 10.4 10.4
Death (%) 0 0
MI (%) 10.4 10.1
Major bleeding (%) 0.8 0.0
Minor bleeding (%) 3.2 0.8

He concluded: "Our results suggest that a lower dose of heparin can be safe in patients already pretreated with aspirin and clopidogrel. This strategy can reduce the risk of bleeding. Further studies should also compare new anticoagulants with a lower dose of heparin."

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