Related Experiment Videos
Clinical Experience with Routine Activated Coagulation Time Monitoring During Elective PTCA
1Division of Cardiology, Interventional Cardiology and Thrombosis Research Center, Clinical Trials Section, University of Massachusetts Medical School, Worcester, MA.
Insights
Activated coagulation time (ACT)-guided heparin dosing significantly reduces acute and delayed vessel closure during percutaneous coronary interventions (PCI). This strategy proves effective even for high-risk patients undergoing PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Intracoronary thrombosis is a key factor in acute complications during percutaneous coronary interventions (PCI).
- Activated Coagulation Time (ACT) is a standard bedside test for monitoring heparin's anticoagulant effect during PCI.
- Empirical heparin dosing strategies may not adequately address patient-specific risks.
Purpose of the Study:
- To evaluate if ACT-adjusted heparin dosing reduces procedure-related complications in elective percutaneous transluminal coronary angioplasty (PTCA).
- To compare complication rates between empirical heparin dosing and ACT-guided heparin administration.
Main Methods:
- A retrospective study of 1200 patients undergoing elective PTCA between January 1988 and February 1992.
- Patients were divided into two groups: empirical heparin (Group 1) and ACT-guided heparin (Group 2).
- Clinical, angiographic, and procedural data were analyzed to compare complication rates.
Main Results:
- Group 2 patients had a higher-risk profile (older, worse LV function, prior MI) than Group 1.
- ACT-guided heparin therapy (Group 2) resulted in a ~50% reduction in abrupt vessel closure (6.9% vs. 3.5%).
- Delayed vessel closure was significantly reduced by over 60% in Group 2 (3.2% vs. 1.0%).
Conclusions:
- ACT-guided heparin therapy during PCI effectively decreases both acute and delayed vessel closure.
- This approach improves outcomes even in patients with clinical and angiographic characteristics predicting higher complication rates.
- ACT monitoring offers a superior strategy for heparin management in PCI compared to empirical dosing.
Abstract:
Background: Intracoronary thrombosis is an important factor in the pathogenesis of acute complications during percutaneous coronary interventions. The activated coagulation time (ACT) is a simple, reproducible bedside test that has become standard as the means of monitoring the anticoagulant effect of heparin during these procedures. To determine if ACT-adjusted heparin dosing reduces the procedure-related complications of elective PTCA, 1200 patients who underwent nomemergent percutancous transluminal coronary angioplasty (PTCA) between January 1, 1988 and February 26, 1992 were studied. MethodslResults: Two groups were identified based on the use of empirical heparin dosage (group 1, before July 1, 1990) vs. ACT-guided heparin administration strategies (group 2, after July 1, 1990). Group 2 patients were older, had worse left ventricular function, and were more likely to have experienced a prior myocardial infarction than patients in group 1. Patients in group 1 were more likely to have chronic stable angina and a positive exercise test, while group 2 patients were more likely to be undergoing PTCA for post-myocardial infarction (MI) angina. Angiographic characteristics were also consistent with a higher risk profile in group 2 than in group 1 (92.7% vs. 83.4%, p < 0.001). Postprocedural complications, including abrupt closure and late closure, were lower in group 2 patients. The incidence of abrupt vessel closure was decreased by approximately 50% (6.9% vs. 3.5%, p < 0.025), and delayed vessel closure was significantly reduced by over 6017,(3.2% vs. 1.0%, p < 0.05). There were no differences in femoral artery complications between the two specified groups. Conclusion: ACT-guided heparin therapy during percutaneous coronary interventions decreases acute and delayed vessel closure, even in the presence of clinical and angiographic characteristics that would predict a higher incidence of these events.