Stents, antithrombotic agents and vascular complications. Does site of arterial access make a difference?

growing extent direct thrombin inhibitors such as hirudin and hirulog, and the newer low molecular weight heparins, principally enoxaparin and dalteparin, are also being used during the procedure. In the EPIC study, the first large trial with abciximab in coronary intervention, a full dose heparin bolus was given to achieve an activated clotting time of 300–350 s. This resulted in a much higher bleeding rate with abciximab compared to placebo; 14·0% vs 6·6%. A similar high incidence of bleeding was found in RAPPORT, a study with abciximab in acute myocardial infarction, where the same heparin dose was employed. Thus, although there have been several factors increasing the tendency towards more bleedings and peripheral vascular complications over the years, there have simultaneously been developments in other directions. On the pharmacological side, we have learnt to optimize the antithrombotic regimen in various ways. The use of the activated clotting time to monitor the dose and effect of heparin during the procedure has been useful in order to avoid excessive levels of anticoagulation with the associated risk of bleeding and also to ensure that a sufficient heparin dose is given to protect from thrombotic complications. Use of heparin coated stents also facilitated a less aggressive anticoagulation regimen which reduced the incidence of bleedings without the occurrence of subacute stent thrombosis. Another important advance was the demonstration that ticlopidine administration following stent implantation in comparison to conventional anticoagulation therapy with intravenous heparin followed by oral antivitamin K resulted in a reduced incidence of both cardiac events and haemorrhagic and vascular complications. These findings have later been corroborated by other studies. Because of the haematological complications associated with Stents, antithrombotic agents and vascular complications. Does site of arterial access make a difference?