The use of heparinization to prevent arterial thrombosis after percutaneous cardiac catheterization in children

Abstract

Thrombosis at the site of arterial puncture is a common and serious complication of percutaneous cardiac catheterization in children. A double blind study was therefore designed to test the efficacy of heparin, administered during catheterization, in reducing this complication. 161 Unselected children over 1 yr of age were studied. Prior to catheterization, the pulse amplitudes were measured in both legs using a pulse volume recorder (a standardized oscillometer). Immediately after arterial cannulation, heparin, 1 mg/kg, or a placebo was administered. On the morning following catheterization, the pulse amplitude in both legs was remeasured, and a pulse volume index calculated using the uncatheterized leg as a control. Patients in whom the catheterized leg was cold, with poor capillary filling and absent arterial pulses 4 hr after the completion of catheterization, were started on intravenous infusion of heparin. If no improvement occurred within 48 hr, embolectomy was performed. There was no evidence of arterial compromise to the catheterized extremity to any patient older than 10 yr. Of 77 children 10 yr of age or younger, systemic heparinization postcatheterization was required for a pulseless extremity in 40% (15/37) of those in the placebo group and 8% (3/40) in the heparin group (P=0.003). Only 5% (2/40) of children in the heparinized group had a pulse volume index of less than 50%, compared to 27% (10/37) in the placebo group (P=0.003). Embolectomy was performed in seven of the 37 children in the placebo group and none of the 40 in the heparin group (P=0.003). Embolectomy was performed in seven of the 37 children in the placebo group and none of 40 in the heparin group (P=0.01). No complications related to the use of heparin were found. It was concluded that heparin administered during percutaneous catheterization is effective in preventing arterial thrombosis in children 10 yr of age or younger, and should be routinely administered unless a specific contraindication to its use exists.