Can you stop heparin infusion after Left Heart Catheterization (LHC) if Percutaneous Coronary Intervention (PCI) happens?

Heparin Infusion After PCI

Yes, you should discontinue heparin infusion after PCI for uncomplicated cases. 1

Evidence-Based Recommendations for Anticoagulation Management After PCI

Discontinuation of Anticoagulants After Successful PCI

• ACC/AHA guidelines explicitly recommend discontinuing anticoagulant therapy after PCI for uncomplicated cases (Level of Evidence: B) 1
• Routine post-procedure heparin infusion is not recommended as it could increase the occurrence of bleeding without significantly reducing ischemic complications 2
• After successful PCI, the focus should shift to monitoring for recurrent ischemia, achieving hemostasis at the catheter insertion site, and preventing contrast-induced renal failure 1

Anticoagulation Management Based on Clinical Scenario

• For patients undergoing PCI without complications, heparin infusion should be discontinued after the procedure 1
• For patients with specific clinical indications for continued anticoagulation (such as residual thrombus or significant residual dissections), subcutaneous administration of unfractionated heparin may provide a safer and less costly means of extending antithrombin therapy than intravenous unfractionated heparin 1
• In patients requiring long-term anticoagulation (e.g., atrial fibrillation), oral anticoagulant therapy can be resumed within 24 hours after PCI, based on assessment of bleeding risk and post-procedure complications 1

Post-PCI Antithrombotic Management

Antiplatelet Therapy

• Continue aspirin (Level of Evidence: A) 1
• Administer a loading dose of clopidogrel if not started before diagnostic angiography (Level of Evidence: A) 1
• For high-risk patients, particularly those who are troponin-positive, consider glycoprotein IIb/IIIa inhibitors if not started before diagnostic angiography 1

Considerations for Special Populations

• For patients on chronic oral anticoagulation (e.g., atrial fibrillation) who undergo PCI:
  • Assess access site for adequacy of hemostasis before restarting anticoagulation 1
  • Consider patient factors including history of recent bleeding, body habitus, and platelet abnormalities 1
  • In most patients, oral anticoagulant therapy can be resumed within 24 hours after PCI 1

Common Pitfalls and Caveats

• Continuing heparin infusion after uncomplicated PCI may increase bleeding risk without providing additional benefit 2
• Crossing over between different anticoagulant therapies (e.g., switching from enoxaparin to unfractionated heparin) may increase bleeding risk 1
• For patients on low-molecular-weight heparin, remember that ACT should not be used as a guide to anticoagulation therapy 1
• If bivalirudin was used during PCI, it should be discontinued after the procedure for uncomplicated cases, as continuing it has not shown significant reduction in ischemic events compared to discontinuation 3

Algorithm for Post-PCI Anticoagulation Management

1. Assess if the PCI was uncomplicated:

   • If uncomplicated → Discontinue heparin infusion 1
   • If complicated (residual thrombus, significant dissection) → Consider subcutaneous heparin instead of IV infusion 1

2. Evaluate need for long-term anticoagulation:

   • If no indication → Proceed with standard dual antiplatelet therapy 1
   • If indication exists (e.g., atrial fibrillation) → Resume oral anticoagulant within 24 hours based on bleeding risk assessment 1

3. Continue appropriate antiplatelet therapy:

   • Continue aspirin 1
   • Ensure P2Y12 inhibitor loading and maintenance 1

By following these evidence-based recommendations, you can optimize outcomes while minimizing bleeding risk in patients undergoing PCI.