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Low-Dose Heparin May Not Be Better Than Standard-Dose

Does not appear to reduce major peri-PCI bleeding, vascular access site complications

TUESDAY, Sept. 21 (HealthDay News) -- In high-risk patients with non-ST-segment elevation acute coronary syndromes initially treated with fondaparinux, low-dose heparin does not appear to reduce major peri-percutaneous coronary intervention (PCI) bleeding or vascular access site complications, according to research published in the Sept. 22/29 issue of the Journal of the American Medical Association.

Philippe Gabriel Steg, M.D., of the Assistance Publique-Hôpitaux de Paris, and colleagues analyzed outcomes in 2,026 non-ST-segment elevation acute coronary syndrome patients undergoing PCI within 72 hours who were initially treated with fondaparinux. The patients were randomized to either low-dose unfractionated heparin, 50 U/kg, or standard-dose unfractionated heparin, 85 U/kg (60 U/kg with glycoprotein IIIa inhibitors).

The researchers found the composite of major bleeding, minor bleeding, or major vascular access-site complications within 48 hours of PCI in 4.7 percent of the low-dose group and 5.8 percent of the standard-dose group (P = .27). Rates of major bleeding were the same in both groups, but minor bleeding rates were significantly lower in the low-dose group than in the standard-dose group, 0.7 versus 1.7 percent.

"Low-dose compared with standard-dose unfractionated heparin did not reduce major peri-PCI bleeding and vascular access-site complications," the authors write.

The study was funded by GlaxoSmithKline; several authors disclosed financial relationships with medical device and/or pharmaceutical companies, including GlaxoSmithKline.

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