Comparison of anticoagulation efficacy and safety of different heparin dosages in cardiogenic shock patients supported by intra-aortic balloon pump: A retrospective cohort study

The study aimed to evaluate whether a half-dose heparin flush strategy during intra-aortic balloon pump (IABP) support improves safety compared with the standard-dose strategy in patients with cardiogenic shock (CS). In this single-center retrospective cohort study, 128 CS patients who received IABP support between January 2023 and December 2024 were included. Sixty-eight patients received a standard-dose heparin flush, and 60 received a half-dose flush. The primary endpoints were clinically relevant bleeding (Bleeding Academic Research Consortium 2, 3, or 5) and thrombocytopenia (platelet count < 100 × 109/L). Multivariable logistic regression was conducted, adjusting for dual antiplatelet therapy and renal dysfunction. The incidence of clinically significant bleeding events and thrombocytopenia was significantly lower in the half-dose group than in the standard-dose group (P < .05). Compared with the standard-dose group, the half-dose heparin flush strategy was significantly associated with a lower risk of clinically significant bleeding (odds ratio = 0.15; 95% confidence interval = 0.03-0.68). Among the secondary outcomes, the half-dose group had a significantly lower transfusion requirement than the standard-dose group (P < .001). No significant differences were observed between the 2 groups in activated partial thromboplastin time, activated clotting time, in-hospital mortality, or catheter-related occlusion events. In patients with CS receiving IABP support, the half-dose heparin flush strategy was associated with lower incidences of thrombocytopenia, clinical bleeding, and transfusion requirements. No device-related thrombotic events were observed in either group, suggesting that the half-dose heparin flush strategy may contribute to optimizing anticoagulation management during the peri-support period.