We have celebrated the 20th anniversary of the first percutaneous transluminal coronary angioplasty (PTCA) by Grüntzig. We have seen many efforts to render PTCA simpler and safer. While technological progresses have allowed us to approach ever more complex coronary lesions, there has been a tremendous effort to optimise medical treatment as an adjunct to mechanical dilatation of coronary lesions. A variety of anticoagulant and antiplatelet agents have been used from the beginning to minimise the risk of abrupt coronary occlusion during and after PTCA.

Various studies have shown that heparin and aspirin significantly reduce the incidence of acute ischaemic complications of PTCA. Other antiplatelet and antithrombotic agents have been used for the same purpose.1 Some of the initial drugs were of little help or even harmful and they were abandoned. For example, for intracoronary stents periprocedural anticoagulation was initially considered essential, until objective data favoured more simple drug regimens.2

The exact dose of heparin needed during coronary interventions and the length of postprocedural heparin infusion is not yet established. Pretreatment with heparin in patients with intracoronary thrombus and unstable angina has reduced the incidence of acute ischaemic complications.3 In many centres, an initial bolus of 10 000–15 000 units of heparin and further boluses to …