Can Shorter Fluoroscopic Time Obviates the Need of Routine Heparin Use in Coronary Angiography via Femoral Route? A Prospective Study

• Main Authors: Om Murti Anil, Nabin Chaudhary, Arun Sayami, Saheb Kumar Jayswal, Naresh Maharjan, Bhawani Manandhar, Paras Koirala, Ujit Kumar Karmacharya
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Journal of Clinical and Preventive Cardiology
• Subjects: complications; coronary angiography; femoral artery approach; fluoroscopy time; without heparin
• Online Access: http://www.jcpconline.org/article.asp?issn=2250-3528;year=2019;volume=8;issue=4;spage=161;epage=165;aulast=Anil

Background: The use of heparin in coronary angiography (CAG) through radial route is a well-known practice. However, the prophylactic use of heparin following the femoral arterial sheath insertion is still controversial, so we aimed to assess the safety of CAG without the use of heparin through femoral approach by minimizing fluoroscopy time. Methods: All patients undergoing diagnostic CAG through femoral approach were enrolled in our study. Heparin was not given after femoral sheath insertion contrary to the usual practice. Depending on the fluoroscopy time, patients were divided into three groups: (a) group with fluoroscopy time <2 min, (b) group with fluoroscopy time 2–5 min, and (c) group with fluoroscopy time 5–10 min. The study patients were prospectively assessed for any thrombus formation or embolic event. Femoral puncture site and other complications were also studied simultaneously. Patients with primary/elective angioplasty and longer fluoroscopy time (>10 min) were excluded from the study as well as those who received heparin. Results: Altogether, 1550 patients were enrolled in the study over a period of 3 years. The mean age of the study population was 57.0 ± 12.5 years; 71% of the patients were male. Fluoroscopy time was <2 min in 63% of the patients, 2–5 min in 33% of the patients, and 4% of the patients had fluoroscopy time of 5–10 min. No thromboembolic clinical events were recorded in the entire population during the study. Femoral sheath thrombus was seen in only 2.9% of the patients, and all of these cases had a fluoroscopy time of ≥5 min. Conclusion: CAG can be safely performed through femoral route without the use of heparin and without any associated thromboembolic complications if fluoroscopy time is <10 min.