Weight and heparin doses for angiography and angioplasty for a patient

Weight and heparin doses for angiography and angioplasty for a patient in cathlab

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heparin dosing cath lab angiography angioplasty PCI weight based ACT target 2025

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https://www.ncbi.nlm.nih.gov/books/NBK543578

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Heparin Dosing in the Cath Lab: Angiography vs. Angioplasty (PCI)

The key principle is that heparin dosing differs depending on whether you are doing diagnostic angiography only vs. proceeding to PCI (angioplasty/stenting), and whether a glycoprotein IIb/IIIa inhibitor (GPI) is planned.

1. Diagnostic Coronary Angiography (Cath only, no intervention)

	Dose
UFH bolus	2,000 - 5,000 units IV (or ~50 U/kg) via arterial sheath on entry
Purpose	Prevent thrombus formation on catheters/sheaths; not full anticoagulation
ACT target	Not routinely required for diagnostic-only cases
GPI	Not used for diagnostic cath

Some labs use a flat 3,000-5,000 U flush with sheath insertion for transfemoral access.
For transradial access, a higher bolus (~5,000 U or 50-70 U/kg) is often given to prevent radial artery spasm/thrombosis.

2. PCI / Angioplasty (Intervention - Stenting, Balloon)

This is where weight-based dosing becomes mandatory.

UFH (Unfractionated Heparin) - Standard Drug of Choice

Scenario	UFH Dose	ACT Target
PCI without GPI	70-100 U/kg IV bolus	250-300 s (Hemotech) / 300-350 s (Hemochron)
PCI with GPI (abciximab, eptifibatide, tirofiban)	50-70 U/kg IV bolus	200-250 s
Prior anticoagulation given (e.g., came on heparin infusion)	Additional UFH as needed	ACT 250-300 s

Per 2025 ACC/AHA/SCAI guidelines: for PCI without prior anticoagulation, give 70-100 U/kg bolus to achieve ACT 250-300 s.
Per ESC 2017/2023 guidelines: 70-100 U/kg without GPI; 50-70 U/kg with GPI.

ACT Monitoring

Check ACT 5-10 minutes after initial heparin bolus.
If ACT is subtherapeutic, give additional 2,000-5,000 U boluses and recheck.
Check ACT every 20-30 min during the procedure if prolonged.
Do not proceed with PCI until ACT is in target range.

3. Quick Reference Table (Practical Cath Lab Use)

Patient Weight	PCI Dose (No GPI) @ 70 U/kg	PCI Dose (No GPI) @ 100 U/kg	PCI + GPI @ 50-70 U/kg
50 kg	3,500 U	5,000 U	2,500 - 3,500 U
60 kg	4,200 U	6,000 U	3,000 - 4,200 U
70 kg	4,900 U	7,000 U	3,500 - 4,900 U
80 kg	5,600 U	8,000 U	4,000 - 5,600 U
90 kg	6,300 U	9,000 U	4,500 - 6,300 U
100 kg	7,000 U	10,000 U	5,000 - 7,000 U

Most cath labs cap the initial dose at 10,000 U regardless of weight.

4. Alternative Anticoagulants (when heparin is contraindicated - e.g., HIT)

Drug	Dose
Bivalirudin	0.75 mg/kg bolus IV, then 1.75 mg/kg/hr infusion during PCI
Enoxaparin	0.5-1 mg/kg IV bolus; ACT target ~200 s (with GPI) or ~225 s (without)

5. Post-Procedure

After diagnostic cath: Sheath can be removed when ACT < 150-180 s (femoral). Radial bands allow immediate removal.
After PCI: No routine post-procedure heparin infusion is needed in patients on dual antiplatelet therapy (aspirin + P2Y12 inhibitor). Sheath removal at ACT < 150-180 s (femoral).
Heparin infusion post-PCI is only continued in specific situations: mechanical complications, large thrombus burden, or bridging in select cases.

Key Points to Remember in the Cath Lab

Always weigh the patient before the case - use ideal/actual body weight (most centers use actual body weight for heparin; in morbidly obese patients some use adjusted body weight).
Always check ACT after the bolus before proceeding with PCI.
Lower dose if GPI is used - GPI + high-dose heparin = significant bleeding risk.
Radial access allows earlier sheath removal regardless of ACT.

Sources: 2025 ACC/AHA/SCAI PCI Guidelines | SCAI Anticoagulation Monitoring | Tintinalli's Emergency Medicine, p. 3581-3583 | Fuster and Hurst's The Heart, 15th Ed. | NIH/NCBI Primary PCI Anticoagulants

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