Can Heparin Be Discontinued After PCI?
Yes, heparin should be discontinued immediately after uncomplicated PCI in patients started on dual antiplatelet therapy (DAPT). 1
Standard Post-PCI Anticoagulation Management
Discontinue parenteral anticoagulation immediately after the invasive procedure unless specific clinical indications exist for continued anticoagulation. 2 The ACC/AHA guidelines explicitly recommend stopping anticoagulant therapy after PCI for uncomplicated cases (Level of Evidence: B). 1
Why Heparin Should Be Stopped
Post-PCI heparin increases bleeding risk without cardiovascular benefit. The most recent high-quality evidence from the STOPDAPT-3 trial (2024) demonstrated that post-PCI heparin was associated with significantly increased bleeding (4.75% vs 2.52%, adjusted HR 1.69, p=0.007) and a numerically increased risk of cardiovascular events (3.16% vs 1.72%, adjusted HR 1.56, p=0.06). 3
Higher heparin doses correlate with worse outcomes. Both higher hourly doses and total doses of heparin were associated with increased incidence of bleeding and cardiovascular events within 30 days. 3
DAPT provides adequate antithrombotic protection. After successful PCI, the focus shifts to DAPT (aspirin plus P2Y12 inhibitor), which provides sufficient protection against stent thrombosis and ischemic events. 1, 4
Post-PCI Antithrombotic Strategy
Immediate Post-PCI Period
Continue aspirin indefinitely (75-100 mg daily). 4
Administer P2Y12 inhibitor loading dose if not given before diagnostic angiography:
DAPT Duration
For acute coronary syndrome: Continue DAPT for 12 months regardless of stent type. 2, 4
For stable coronary disease: Continue DAPT for minimum 6 months after drug-eluting stent implantation. 4
For high bleeding risk patients (PRECISE-DAPT ≥25): Consider discontinuing P2Y12 inhibitor at 6 months. 2
Specific Indications for Continued Anticoagulation
When Heparin May Be Continued (Rare Situations)
The golden rule is to avoid continuing antithrombins after PCI except in specific individual situations such as thrombotic complications during the procedure. 2
If continued anticoagulation is required for specific clinical indications:
Subcutaneous unfractionated heparin provides a safer and less costly option than intravenous heparin for extending antithrombin therapy. 1
Resume oral anticoagulation within 24 hours after PCI in most patients requiring long-term anticoagulation, after assessing hemostasis at the access site. 1, 5
Patients Requiring Long-Term Oral Anticoagulation
For patients with atrial fibrillation or other indications for chronic anticoagulation:
Administer aspirin plus clopidogrel during the immediate peri-PCI phase through hospital discharge. 4, 5
Discontinue aspirin at hospital discharge or within 1 week and transition to double therapy (oral anticoagulant + clopidogrel 75 mg daily). 4, 5
Prefer a direct oral anticoagulant (DOAC) over warfarin at established stroke prevention doses. 4, 5
Continue P2Y12 inhibitor for 6-12 months depending on ischemic and bleeding risk, then discontinue antiplatelet therapy and continue oral anticoagulation alone. 6
Critical Pitfalls to Avoid
Never crossover between UFH and low molecular weight heparin (LMWH) as this significantly increases bleeding risk. 2, 1
Do not use bridging anticoagulation routinely in patients on DOACs—bridging is not recommended. 2
For patients on fondaparinux pre-PCI, give a single bolus of UFH (85 IU/kg, or 60 IU/kg with concomitant GP IIb/IIIa inhibitors) during the procedure, then discontinue. 2
Assess access site hemostasis carefully before restarting any anticoagulation, considering patient factors including recent bleeding history, body habitus, and platelet abnormalities. 1