Higher-Dose Heparin Shows No Benefit in PCI
A cluster-randomised trial found a 100 U/kg heparin bolus did not reduce death, heart attack, or repeat revascularisation versus 70 U/kg during elective procedures.
Updated on Nov. 2, 2026 in Heart Disease
The HD-PCI trial compared higher-dose and lower-dose unfractionated heparin during elective percutaneous coronary intervention and found no significant difference in the 30-day composite of death, myocardial infarction, or target vessel revascularisation. Major bleeding rates were also similar between the two groups.
Why it matters
Heparin dosing during coronary procedures is a routine clinical decision, and the trial suggests that increasing the dose does not translate into better short-term outcomes for patients undergoing elective PCI. The findings may prompt clinicians to reconsider whether higher-intensity anticoagulation adds value in this setting.
The trial enrolled 11,619 patients across 11 hospitals, falling short of the 16,152 planned, with a 30-day composite event rate of 1.2% in the higher-dose group versus 1.0% in the lower-dose group. Exploratory analyses showed ACT values below 250 seconds were less frequent with the 100 U/kg bolus at two centres, but the trial lacked routine post-PCI biomarker data, leaving its clinical significance unresolved.
The players
McMaster University
A research university in Hamilton, Ontario, whose affiliated investigators led the HD-PCI trial and are known for cardiovascular and clinical trial research.
The details
Investigators randomised hospitals to alternating crossover periods in which each site followed a site-wide policy of either a 70 U/kg or a 100 U/kg intravenous heparin bolus. The trial was presented at the TCT 2026 meeting, and its lead researchers are affiliated with McMaster University in Hamilton, Ontario.
Timeline
November 2, 2026: HD-PCI trial results presented at the TCT 2026 meeting
Health Landscape
The HD-PCI trial adds to a body of randomised work on anticoagulant intensity during coronary intervention, testing whether a higher heparin bolus improves on standard practice. Its null finding on death, infarction, and repeat revascularisation shifts the question toward whether intensity adjustments justify their added procedural complexity.
For patients scheduled for elective angioplasty, the trial suggests that the standard heparin dose is not outperformed by a higher dose on short-term outcomes. Bleeding risk was equivalent between groups, so the findings do not point to a change in what patients should expect from the procedure.
The takeaway
The trial indicates that intensifying heparin dosing in elective PCI did not reduce death, heart attack, or repeat revascularisation in this study. Clinicians and patients may find these results useful when weighing anticoagulation strategies for routine procedures.
Further reading
For broader context on treatment research, see Heart Disease coverage on Wisevoter.
