PREDICTORS OF HAEMATOMA DEVELOPMENT AMONG IN- PATIENTS UNDERGOING CARDIAC CATHETERISATION; THE IMPORTANCE OF TIMING OF ANTICOAGULANT THERAPY.
M.Gaynor*, S.B.Freedman, D.Brieger.
Dept. of Cardiology, University of Sydney, Concord Hospital, Sydney.
The use of newer generation anticoagulant therapies such as low rnolecular weight heparins (LMWH), may place patients with acute coronary syndromes at increased risk of bleeding events, most of which occur following invasive procedures. To obtain information on these events in a clinical setting we developed a registry of in-patients undergoing cardiac catheterisation. Baseline clinical data were collected and angiogram puncture sites were assessed at 4h, 24h, 48h and prior to discharge. Haematomas were measured using a transparent grid and defined as significant if >25 cm2. A total of 169 patients (112 men, 57 women, mean age 64) were included in this study. Admission diagnosis was Q-wave MI in 12, non-Q wave MI in 10, unstable angina in 77, and possible ischaemia in 51. At the time of angiography. 115 (68%) were on LMWH (enoxaparin), (in 97 the drug was withheld on the morning of the angiogram), while 22 were on unfractionated heparin (UFH) and 32 received no anticoagulant therapy. Significant bruising was documented in 38 (22%) and was more frequent in older patients (±75y: 12/33, 36% p=0.03vs < 75y), but not in women (vs men), or in patients with elevated serum creatinine (>150mM). Of the patients receiving anticoagulation, those receiving LMWH on the morning of their angiogram were most likely to experience a haematoma (50%, p=0.014 vs the rest). When these patients were excluded from analysis, LMWH was at least as safe as UFH or no anticoagulant therapy: (haematomas: LMWH 14%, UFH 36%, no anticoagulant 19%, p=0.25).
We conclude that the most powerful predictor of clinically significant haematomas among in-patients undergoing cardiac catheterisation is the administration of LMWM on the morning of the procedure. Provided this dose is withheld, use of LMWH confers no additional risk in this setting.
