Evaluating the Use of Unfractionated Heparin with Intra-Aortic Balloon Counterpulsation.

Evidence supporting anticoagulation with unfractionated heparin (UFH) in patients with an intra-aortic balloon pump (IABP) to prevent limb ischaemia remains limited, while bleeding risks remain high. Monitoring heparin in this setting with anti-factor Xa (anti-Xa) is not previously described. The study objective is to describe the incidence of thromboembolic and bleeding events with the use of UFH in patients with an IABP utilising monitoring with both anti-Xa and activated partial thromboplastin time (aPTT). This is a retrospective study of adults who received an IABP and UFH for ≥24 hours. Electronic medical records were reviewed for pertinent data. The primary outcome was the incidence of limb ischaemia during IABP. Secondary outcomes included myocardial infarction, thrombus on IABP, or stroke. Exploratory outcomes included any venous thromboembolism and bleeding events. Of 159 patients, 88% received an IABP for cardiogenic shock and median duration of IABP support was 118 hours (interquartile range, 67–196). Limb ischaemia occurred in four of 159 patients (2.5%). Strokes occurred in 3.8% of the cohort, and bleeding events occurred in 33%. Despite anticoagulation use in all patients, 11% experienced a venous thromboembolism, with most identified upon asymptomatic screening with concern for heparin-induced thrombocytopenia. We found no differences in outcomes that occurred with a hybrid anti-Xa and aPTT versus aPTT monitoring alone. We observed a high rate of thrombotic and bleeding complications with the use of UFH in patients with an IABP. Use of anti-Xa versus aPTT for monitoring was not associated with complications. These data suggest safer anticoagulation strategies are needed in this setting. • Utilization of unfractionated heparin titrated to therapeutic aPTT and/or anti-Xa in patients requiring hemodynamic support with an IABP may not be required for all. • Patient characteristics, such as increased thromboembolic or bleeding risk, should be assessed and careful consideration of anticoagulation goals should be determined at the bedside. • Given a paucity of data, evaluation of heparin monitoring with anti-Xa during IABP support requires further investigation. • Further research is needed to understand optimal goals of anticoagulation therapy if utilized, specifically if therapeutic levels are necessary or if prophylactic goals can be targeted to reduce the risk of bleeding without increasing thromboembolic events in patients supported with an IABP. [ABSTRACT FROM AUTHOR]