CardioVascular and Interventional Radiology

, Volume 36, Issue 6, pp 1477–1492

Periprocedural Prophylactic Antithrombotic Strategies in Interventional Radiology: Current Practice in the Netherlands and Comparison with the United Kingdom

  • Arno M. Wiersema
  • Jan-Albert Vos
  • Cornelis M. A. Bruijninckx
  • Otto M. van Delden
  • Michel M. P. J. Reijnen
  • Anco Vahl
  • Clark J. Zeebregts
  • Frans L. Moll
Clinical Investigation

DOI: 10.1007/s00270-013-0558-6

Cite this article as:
Wiersema, A.M., Vos, JA., Bruijninckx, C.M.A. et al. Cardiovasc Intervent Radiol (2013) 36: 1477. doi:10.1007/s00270-013-0558-6



The use of prophylactic antithrombotic drugs to prevent arterial thrombosis during the periprocedural period during (percutaneous) peripheral arterial interventions (PAIs) is still a matter of dispute, and clear evidence-based guidelines are lacking. To create those guidelines, a study group was formed in the Netherlands in cooperation with the Dutch Society of Vascular Surgery and the Society of Interventional Radiology. The study group is called “Consensus on Arterial PeriProcedural Anticoagulation (CAPPA).”

Materials and Methods

The CAPPA study group devised and distributed a comprehensive questionnaire amongst Dutch interventional radiologists (IRs).


One hundred forty-two IRs responded (68 %) to the questionnaire. Almost no IR stopped acetyl salicylic acid before interventions, and 40 % stopped clopidogrel before PAI but not before carotid artery stenting (CAS). A flushing solution on the sideport of the sheath was used routinely by 30 % of IRs in PAI and by 50 % of IRs during CAS. A minority of IRs used a heparinised flushing solution (28 %). Unfractionated heparin was used by 95 % of IRs as bolus; 5000 IU was the most used dosage. Timing of administration varied widely. A majority of IRs (75 %) repeated heparin administration after 1 h.


A substantial variety exists amongst IRs in the Netherlands regarding the use of prophylactic periprocedural antithrombotic drugs to prevent arterial thrombosis during PAI. When compared with varying results regarding the use of heparin in the United Kingdom, the variety in the Netherlands showed a different pattern. The proven variety in these countries, and also between these countries, emphasises the need for authoritative studies to develop evidence-based practical guidelines.


Clinical practise Arterial intervention Angioplasty/angiogram Endovascular treatment Arteriosclerosis 

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Arno M. Wiersema
    • 1
  • Jan-Albert Vos
    • 2
  • Cornelis M. A. Bruijninckx
    • 3
  • Otto M. van Delden
    • 4
  • Michel M. P. J. Reijnen
    • 5
  • Anco Vahl
    • 6
  • Clark J. Zeebregts
    • 7
  • Frans L. Moll
    • 8
  1. 1.Department of SurgeryWestfriesgasthuis, HoornHoornThe Netherlands
  2. 2.Department of Radiology, Division of Interventional RadiologySt Antonius Hospital, NieuwegeinNieuwegeinThe Netherlands
  3. 3.Department of SurgeryEquipe Zorg Bedrijven, RotterdamEindhovenThe Netherlands
  4. 4.Department of Radiology, Division of Interventional RadiologyAcademic Medical Centre, University of AmsterdamAmsterdamThe Netherlands
  5. 5.Department of SurgeryRijnstate Hospital, ArnhemArnhemThe Netherlands
  6. 6.Department of SurgeryOnze Lieve Vrouwe Gasthuis, AmsterdamAmsterdamThe Netherlands
  7. 7.Department of Surgery, Division of Vascular Surgery, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
  8. 8.Department of Surgery, Division of Vascular Surgery, University Medical Centre UtrechtUniversity of UtrechtUtrechtThe Netherlands

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