HD-PCI Study Compares Higher-Dose and Lower-Dose Heparin Strategies During PCI

November 1, 2026—New results from the HD-PCI study were presented by Sanjit S. Jolly, MD, at TCT 2026. The findings showed that a higher-dose regimen of unfractionated heparin (UFH) did not improve clinical outcomes compared with a lower-dose strategy during percutaneous coronary intervention (PCI), reported the TCT press release.

According to TCT, the HD-PCI study was designed to determine whether a lower or higher-dose UFH strategy offers the best balance between ischemic protection and bleeding risk in contemporary elective PCI. The study was funded by PHRI, the Population Health Research Institute, which is jointly supported by McMaster University and Hamilton Health Sciences in Hamilton, Canada.

“Despite the need to balance ischemic protection against bleeding risk, randomized evidence to guide the optimal dose of UFH for elective PCI has been limited,” commented Dr. Jolly in the TCT press release. “In HD-PCI, a higher-dose strategy offered no added benefit in contemporary practice. These findings suggest that a lower dose of 70 U/kg of heparin is sufficient, with activated clotting time measured at 30 minutes for prolonged procedures.”

As summarized in the press release, HD-PCI was a multicenter, randomized, controlled, registry-based, open-label, cluster crossover trial conducted at 11 PCI centers in Canada. From March 2022 to November 2024, the study enrolled 11,619 patients, representing 72% of the target sample size. Patient and procedural characteristics were similar between both groups.

Hospitals were randomized to implement institutional UFH dosing strategies of either 70 U/kg (n = 5,778) or 100 U/kg (n = 5,841) for elective PCI, with crossover between treatment periods. Adult patients undergoing elective PCI with stable coronary artery disease were eligible for inclusion. Chronic total occlusion cases were excluded, noted TCT.

The primary efficacy outcome was defined as the composite of all-cause death, myocardial infarction, or target vessel revascularization within 30 days of the initial PCI procedure.

The TCT press release reported that the study showed the following:

• There was no statistical difference between events in the higher-dose UFH group (n = 70) and the lower-dose UFH (n = 55) group (95% CI, 1.29 [0.89-1.87]; P = .17).
• For the primary safety outcome of major bleeding, the incidence among the higher-dose (n = 58) and lower-dose groups (n = 59) were also similar (95% CI, 1.03 [0.70-1.52]; P = .87).
• The key net benefit outcome, defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, or major bleeding, was also not statistically significant between the higher-dose (n = 126) and lower-dose (n = 113) groups (95% CI, 1.16 [0.87-1.54]; P = .3).