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Relationship between activated clotting time during percutaneous intervention and subsequent bleeding complications
William B Hillegass1, Brigitta C Brott, Gregory D Chapman
1University of Alabama at Birmingham, Birmingham, Ala 35294-0012, USA. hillegas@uab.edu
American Heart Journal
|September 14, 2002
Summary
High activated clotting time (ACT) during percutaneous coronary intervention increases bleeding risk. Managing ACT is crucial for reducing blood loss and complications, especially in high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hemorrhagic Risk Assessment
Background:
- Percutaneous coronary interventions (PCI) often use unfractionated heparin without additional agents.
- Operators must balance anticoagulation intensity against bleeding risks.
- This study examines factors influencing bleeding after PCI.
Purpose of the Study:
- To clarify the relationship between anticoagulation intensity (ACT) and bleeding complications in PCI.
- To identify patient and procedural predictors of blood loss and bleeding after PCI.
Main Methods:
- Prospective follow-up of 429 patients undergoing PCI for 72 hours.
- Measurement of blood loss via hematocrit changes and tracking of bleeding complications.
- Analysis of in-laboratory activated clotting times (ACT) and other clinical/procedural factors.
Main Results:
- Maximum ACT was significantly linked to blood loss (P=.017) and major bleeding (P=.002).
- Independent predictors of blood loss included age, sex, procedure length, and additional interventions.
- Major bleeding was predicted by age, additional interventions, and maximum ACT.
Conclusions:
- Activated clotting time (ACT) is a significant predictor of bleeding complications post-PCI, second only to patient age.
- Maximum ACT is the most significant modifiable predictor of bleeding.
- Avoiding high-intensity anticoagulation in high-risk patients reduces bleeding complications.