Opposition: Unfractionated heparin should no longer be used in the catheterization laboratory

The goal of anticoagulation during percutaneous coronary intervention (PCI) is the primary and secondary prevention of thrombotic and significant bleeding events that increase cardiovascular morbidity and mortality. Unfractionated heparin is the most commonly-used anticoagulant, but low-molecular weight heparin, and more recently bivalirudin are becoming increasingly popular in cardiac catheterization laboratories(1). The ACC/AHA/SCAI PCI guidelines(2) recommend a 70-100 IU/kg bolus of heparin to achieve an activated clotting time (ACT) of 250-300 seconds for Hemotec and 300-350 seconds for Hemochron systems, when glycoprotein IIb/IIIa inhibitors are not used. When glycoprotein IIb/IIIa inhibitors are used, a bolus of 50-70 IU/kg of unfractionated heparin is recommended to achieve an ACT of 200-250 seconds.