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Periprocedural Prophylactic Antithrombotic Strategies in Interventional Radiology: Current Practice in the Netherlands and Comparison with the United Kingdom

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Abstract

Purpose

The use of prophylactic antithrombotic drugs to prevent arterial thrombosis during the periprocedural period during (percutaneous) peripheral arterial interventions (PAIs) is still a matter of dispute, and clear evidence-based guidelines are lacking. To create those guidelines, a study group was formed in the Netherlands in cooperation with the Dutch Society of Vascular Surgery and the Society of Interventional Radiology. The study group is called “Consensus on Arterial PeriProcedural Anticoagulation (CAPPA).”

Materials and Methods

The CAPPA study group devised and distributed a comprehensive questionnaire amongst Dutch interventional radiologists (IRs).

Results

One hundred forty-two IRs responded (68 %) to the questionnaire. Almost no IR stopped acetyl salicylic acid before interventions, and 40 % stopped clopidogrel before PAI but not before carotid artery stenting (CAS). A flushing solution on the sideport of the sheath was used routinely by 30 % of IRs in PAI and by 50 % of IRs during CAS. A minority of IRs used a heparinised flushing solution (28 %). Unfractionated heparin was used by 95 % of IRs as bolus; 5000 IU was the most used dosage. Timing of administration varied widely. A majority of IRs (75 %) repeated heparin administration after 1 h.

Conclusion

A substantial variety exists amongst IRs in the Netherlands regarding the use of prophylactic periprocedural antithrombotic drugs to prevent arterial thrombosis during PAI. When compared with varying results regarding the use of heparin in the United Kingdom, the variety in the Netherlands showed a different pattern. The proven variety in these countries, and also between these countries, emphasises the need for authoritative studies to develop evidence-based practical guidelines.

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References

  1. Wallace S, Medellin H, De Jongh D et al (1972) Systemic heparinization for angiography. Am J Roentgenol Radium Ther Nucl Med 116(1):204–209

    Article  PubMed  CAS  Google Scholar 

  2. Anderson JH, Gianturco C, Wallace S et al (1974) Anticoagulation techniques for angiography. An experimental study. Radiology 111(3):573–576

    CAS  Google Scholar 

  3. Antonovic R, Rosch J, Dotter CT (1976) The value of systemic arterial heparinization in transfemoral angiography: A prospective study. AJR Am J Roentgenol 127(2):223–235

    Article  PubMed  CAS  Google Scholar 

  4. Kido DK, Paulin S, Alenghat JA et al (1982) Thrombogenicity of heparin- and non-heparin-coated catheters: clinical trail. AJR Am J Roentgenol 139(5):957–961

    Article  PubMed  CAS  Google Scholar 

  5. Lee KH, Han JK, Byun Y et al (2004) Heparin-coated angiographic catheters: an in vivo comparison of three coating methods with different heparin release profiles. Cardiovasc Intervent Radiol 27(5):507–511

    PubMed  Google Scholar 

  6. Kasapis C, Gurm HS, Chetcuti SJ et al (2010) Defining the optimal degree of heparin anticoagulation for peripheral vascular interventions: insight from a large, regional, multicenter registry. Circ Cardiovasc Interv 3(6):593–601

    Article  PubMed  CAS  Google Scholar 

  7. Shammas NW, Lemke JH, Dippel EJ et al (2003) In-hospital complications of peripheral vascular interventions using unfractionated heparin as the primary anticoagulant. J Invasive Cardiol 15(5):242–246

    PubMed  Google Scholar 

  8. Prechel M, Walenga JM (2012, March 7) Heparin-induced thrombocytopenia: an update. Semin Thromb Hemost [E-pub ahead of print]

  9. Rao SV, O’Grady K, Pieper KS et al (2005) Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol 96(9):1200–1206

    Article  PubMed  Google Scholar 

  10. Yatskar L, Selzer F, Feit F et al (2007) Access site hematoma requiring blood transfusion predicts mortality in patients undergoing percutaneous coronary intervention: data from the National Heart, Lung, and Blood Institute Dynamic Registry. Catheter Cardiovasc Interv 69(7):961–966

    Article  PubMed  Google Scholar 

  11. Miller DL (1989) Heparin in angiography: current patterns of use. Radiology 172(3 Pt 2):1007–1011

    Article  PubMed  CAS  Google Scholar 

  12. Zaman SM, de Vroos Meiring P, Gandhi MR et al (1996) The pharmacokinetics and UK usage of heparin in vascular intervention. Clin Radiol 51(2):113–116

    Article  PubMed  CAS  Google Scholar 

  13. Durran AC, Watts C (2012) Current trends in heparin use during arterial vascular interventional radiology. Cardiovasc Intervent Radiol 35(6):1308–1314

    Article  PubMed  Google Scholar 

  14. Norgren L, Hiatt WR, Dormandy JA et al (2007) Inter-society consensus for the management of peripheral arterial disease. Int Angiol 26(2):81–157

    PubMed  CAS  Google Scholar 

  15. Cardiovascular and Interventional Radiological Society of Europe (2012) Standards of Practice. Available at: www.cirse.org. Accessed:

  16. Bittl JA (2005) Bivalirudin vs. heparin in percutaneous coronary intervention: a pooled analysis. J Cardiovasc Pharmacol Ther 10(4):209–216

    Article  PubMed  Google Scholar 

  17. Lincoff AM, Bittl JA, Harrington RA et al (2003) Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: rEPLACE-2 randomized trial. JAMA 289(7):853–863

    Article  PubMed  CAS  Google Scholar 

  18. Stone GW, McLaurin BT, Cox DA et al (2006) Bivalirudin for patients with acute coronary syndromes. N Engl J Med 355(21):2203–2216

    Article  PubMed  CAS  Google Scholar 

  19. Sheikh IR, Ahmed SH, Mori N et al (2009) Comparison of safety and efficacy of bivalirudin versus unfractionated heparin in percutaneous peripheral intervention: a single-center experience. JACC Cardiovasc Interv 2(9):871–876

    Article  PubMed  Google Scholar 

  20. Shammas NW, Shammas GA, Jerin M et al (2010) In-hospital safety and effectiveness of bivalirudin in percutaneous peripheral interventions: data from a real-world registry. J Endovasc Ther 17(1):31–36

    Article  PubMed  Google Scholar 

  21. Walker CM (2010) Commentary: bivalirudin is a safe and effective anticoagulant in the percutaneous treatment of complex infrainguinal disease. J Endovasc Ther 17(1):37–38

    Article  PubMed  Google Scholar 

  22. Stamler S, Katzen BT, Tsoukas AI et al (2009) Clinical experience with the use of bivalirudin in a large population undergoing endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol 20(1):17–21

    Article  PubMed  Google Scholar 

  23. Vahl AC, Reekers JA (2005) The guideline ‘Diagnosis and treatment of peripheral artery disease of the lower extremities’ of The Netherlands Surgical Society. Ned Tijdschr Geneeskd 149(30):1670–1674

    PubMed  CAS  Google Scholar 

  24. Reijnders JMG, Vahl AC, Reekers JA (2006) Diagnostiek en behandeling van perifeer vaatlijden van de onderste extremiteit. Enquete onder chirurgen en radiologen. Ned Tijdschr Heelkunde 15:56–58

    Google Scholar 

  25. Wiersema AM, Jongkind V, Bruijninckx CM et al (2012) Prophylactic perioperative anti-thrombotics in open and endovascular abdominal aortic aneurysm (AAA) surgery: a systematic review. Eur J Vasc Endovasc Surg 44(4):359–367

    Article  PubMed  CAS  Google Scholar 

  26. Reekers JA, Muller-Hulsbeck S, Libicher M et al (2011) CIRSE vascular closure device registry. Cardiovasc Intervent Radiol 34(1):50–53

    Article  PubMed  Google Scholar 

  27. Resnic FS, Arora N, Matheny M, Reynolds MR (2007) A cost-minimization analysis of the angio-seal vascular closure device following percutaneous coronary intervention. Am J Cardiol 99(6):766–770

    Article  PubMed  Google Scholar 

  28. Dauermann HL, Applegate RJ, Cohen DJ (2007) Vascular closure devices: the second decade. J Am Coll Cardiol 50(17):1617–1626

    Article  Google Scholar 

  29. Dunning J, Versteegh M, Fabbri A et al (2008) Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg 34(1):73–92 for the EACTS Audit and Guidelines Committee

    Article  PubMed  Google Scholar 

  30. Castarella PJ, Tcheng JE (2008) Review of the 2005 American College of Cardiology, American Heart Association, and Society for Cardiovascular interventions guidelines for adjunctive pharmacologic therapy during percutaneous coronary interventions: practical implications, new clinical data, and recommended guideline revisions. Am Heart J 155(5):781–790

    Article  Google Scholar 

  31. Bangalore S, Cohen DJ, Kleiman NS et al (2011) Bleeding risk comparing targeted low-dose heparin with bivalirudin in patients undergoing percutaneous coronary intervention: results from a propensity score-matched analysis of the Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry. Circ Cardiovasc Interv 4(5):463–473 for the EVENT Registry Investigators

    Article  PubMed  CAS  Google Scholar 

  32. Lupi A, Rognoni A, Cavalinno C, et al. (2012, September 5) Pharmacological adjuvant therapies in primary coronary interventions: bivalirudin. Cardiovasc Hematol Agents Med Chem [Epub ahead of print]

  33. Betrand OF, Jolly SS, Rao SV et al (2012) Meta-analysis comparing bivalirudin versus heparin monotherapy on ischemic and bleeding outcomes after percutaneous coronary intervention. Am J Cardiol 110(4):599–606

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Westfriesgasthuis, Hoorn, Maelsonstraat 3, 1624 NP, Hoorn, The Netherlands

    Arno M. Wiersema

  2. Department of Radiology, Division of Interventional Radiology, St Antonius Hospital, Nieuwegein, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands

    Jan-Albert Vos

  3. Department of Surgery, Equipe Zorg Bedrijven, Rotterdam, Luchthavenweg 81-235, 5657 EA, Eindhoven, The Netherlands

    Cornelis M. A. Bruijninckx

  4. Department of Radiology, Division of Interventional Radiology, Academic Medical Centre, University of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, The Netherlands

    Otto M. van Delden

  5. Department of Surgery, Rijnstate Hospital, Arnhem, Postbus 9555, 6800 TA, Arnhem, The Netherlands

    Michel M. P. J. Reijnen

  6. Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, Postbus 95500, 1090 HM, Amsterdam, The Netherlands

    Anco Vahl

  7. Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Postbus 30001, 9700 RB, Groningen, The Netherlands

    Clark J. Zeebregts

  8. Department of Surgery, Division of Vascular Surgery, University Medical Centre Utrecht, University of Utrecht, Postbus 85500, 3508 GA, Utrecht, The Netherlands

    Frans L. Moll

Authors
  1. Arno M. Wiersema
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  2. Jan-Albert Vos
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  3. Cornelis M. A. Bruijninckx
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  4. Otto M. van Delden
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  5. Michel M. P. J. Reijnen
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  6. Anco Vahl
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  7. Clark J. Zeebregts
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  8. Frans L. Moll
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Corresponding author

Correspondence to Arno M. Wiersema.

Appendix

Appendix

The full-text questionnaire.

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Wiersema, A.M., Vos, JA., Bruijninckx, C.M.A. et al. Periprocedural Prophylactic Antithrombotic Strategies in Interventional Radiology: Current Practice in the Netherlands and Comparison with the United Kingdom. Cardiovasc Intervent Radiol 36, 1477–1492 (2013). https://doi.org/10.1007/s00270-013-0558-6

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  • DOI: https://doi.org/10.1007/s00270-013-0558-6

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