Safety and Efficacy of Adjunctive Heparin Infusion During Catheter-Directed Thrombolysis for Acute Limb Ischemia

Background Acute limb ischemia (ALI) requires urgent revascularization to prevent limb loss and mortality. Catheter-directed thrombolysis (CDT) is an established treatment; however, the role of concomitant intra-arterial heparin infusion during CDT remains unclear. Current guidelines discourage routine therapeutic heparinization, yet clinical practice varies. This study evaluated the efficacy and safety of adjunctive heparin infusion during CDT for ALI. Methodology A retrospective single-center study was conducted, including all patients who underwent CDT for ALI between November 2022 and May 2024. Patients were categorized into two groups: group 1 received intra-arterial heparin infusion during CDT, whereas group 2 underwent CDT without adjunctive heparin. Outcomes included procedural success (defined as thrombus resolution, limb salvage, and absence of additional revascularization) and complications (death, International Society on Thrombosis and Hemostasis (ISTH)-defined major bleeding, and minor bleeding). Statistical analysis was performed using SPSS version 27 (IBM Corp., Armonk, NY), with significance set at P < 0.05. Results Eighty-one patients were included, with 43 in group 1 and 38 in group 2. Procedural success rates were similar between the groups (74.4% vs. 78.9%, P = 0.632). However, overall complications were significantly higher in group 1 (19/43, 44.2%) compared with group 2 (8/38, 21.1%; P = 0.030). Group 1 had more minor bleeding events (15/43, 34.9%) compared with group 2 (8/38, 21.1%) and accounted for all major bleeding (1/43, 2.3%) and mortality events (2/43, 4.7%). Thrombolysis duration was significantly longer in group 1 (median 28 vs. 15 hours, P = 0.001). Conclusions Concomitant intra-arterial heparin infusion during CDT does not improve procedural success and is associated with higher complication rates, particularly bleeding. These findings support current guideline recommendations against routine heparin infusion during CDT and highlight the need for further prospective research to optimize anticoagulation strategies in ALI management.