wetenschapsdag 2023 | 95 Sessie 3b: Chirurgie Voorbij de Scalpel x5 Auteurs L.C. Roosendaal, M. RadovÇ, M. Hoebink, A.M. Wiersema, J.D. Blankensteijn, V. Jongkind Abstract titel The additional value of activated clotting time guided heparinization during interventions for peripheral arterial disease. Background Unfractionated heparin is widely used to lower the risk of arterial thromboembolic complications (ATEC) during interventions for peripheral arterial disease (PAD), but it is still unknown which heparin dose is the safest in terms of preventing ATEC and bleeding complications. This study aims to evaluate the incidence of complications during interventions for PAD, and the relation between this incidence and different heparinization protocols. Methods A retrospective analysis of a prospective multicenter cohort study was performed. Between June 2015 and September 2022, 355 patients were included who underwent peripheral interventions for PAD. All patients who were included before July 2018 received 5 000 IU of heparin (Group 1). Starting from July 2018, all included patients received an initial dose of 100 IU/kg with potential additional heparin doses based on ACT values (Group 2). Data on ACT values and complications within 30 days post-procedurally were collected. Results In total, 24 ATECs and 48 bleeding complications occurred. In Group 1, 8.7% (n=11) of patients suffered from ATEC, compared to 5.7% (n=13) in Group 2. Thirteen percent of patients (n=17) in Group 1 had a bleeding complication, compared to 14% (n=31) in Group 2. ATECs were more often found in patients with peak ACT values of < 200 s, compared to ACT values between 200-250 s (15% (n=6) versus 5.9% (n=9) respectively, p=0.048). Patients with peak ACT values > 250 s had a higher incidence of bleeding complications compared to an ACT between 200-250 s (24% (n=21) versus 9.8% (n=15) respectively, p=0.003). Forty-four percent of patients (n=23) in Group 1 reached a peak ACT of >200 s, compared to 95% (n= 218) of patients in Group 2 (p=0.001). Conclusion ATEC was found in 6.8% (n=24) and bleeding complications in 14% (n=48) of patients who underwent a procedure for PAD. There was a significantly higher incidence of ATECs in patients with a peak ACT value 250 s. The findings obtained from this study may serve as a basis for conducting future research on heparinization during procedures for PAD, with a larger sample size.
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