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The effect of activated clotting time values for patients undergoing percutaneous coronary intervention: A systematic
Yi-Yue Gui1, Fang-Yang Huang1, Bao-Tao Huang1
1Department of Cardiology, West China Hospital, Sichuan University, China.
Insights
Higher activated clotting time (ACT) values do not significantly impact thrombotic or bleeding events in coronary heart disease patients undergoing percutaneous coronary intervention. Current ACT targets may be unnecessarily high, suggesting lower levels could enhance safety and efficacy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Percutaneous coronary intervention (PCI) requires careful anticoagulation management.
- Activated clotting time (ACT) is a common monitoring tool during PCI.
- Optimal ACT targets for balancing thrombotic and hemorrhagic risks remain debated, especially with varying antiplatelet regimens.
Purpose of the Study:
- To evaluate the impact of higher versus lower activated clotting time (ACT) values on thrombotic and hemorrhagic events in patients with coronary atherosclerotic heart disease (CHD) undergoing PCI.
- To analyze these effects based on the percentage of patients prescribed glycoprotein IIb/IIIa inhibitors (GPI) and the use of direct thrombin inhibitors (DTI).
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Library.
- Observational studies reporting ACT-related major adverse cardiac events (MACE) and major bleeding were included.
- Studies were stratified into three groups based on GPI use (≤30% and >30%) and routine DTI prescription, with specific ACT cutoffs defined for Groups 1 and 2.
Main Results:
- In Group 1 (low GPI use), higher ACT values showed no significant difference in MACE (RR 1.16, p=0.62) or major bleeding (RR 0.96, p=0.83) compared to lower ACT values.
- In Group 2 (high GPI use), higher ACT values also did not significantly differ in MACE (RR 1.15, p=0.10) or major bleeding (RR 0.85, p=0.61) compared to lower ACT values.
- Heterogeneity was noted in some analyses (I²=94% for MACE in Group 1, I²=83% for bleeding in Group 2).
Conclusions:
- Activated clotting time (ACT) may not substantially influence thrombotic or hemorrhagic complications during PCI in CHD patients.
- Current clinical practice may involve target ACT levels higher than necessary for preventing thrombotic events.
- Lowering ACT targets could potentially preserve efficacy while enhancing patient safety.
Abstract:
Our aim was to illustrate the effect of higher activated clotting time (ACT) values versus lower ACT values on thrombotic or hemorrhagic events in coronary atherosclerotic heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI). PubMed, Embase, Web of Science, and Cochrane Library were searched. Observational studies assessing ACT related major adverse cardiac event (MACE) and major bleeding were included. Studies were allocated into three groups. Group 1 included studies with low percentage of participants prescribed with glycoprotein IIb/IIIa inhibitors ([GPI] ≤30%), Group 2 with high percentage of participants prescribed with GPI (>30%), and Group 3 with routine direct thrombin inhibitors (DTI) prescription. The cutoff is designed as 300s (290-310s) for Group 1, and 250s (240-260s) for Group 2. With regard to MACE and major bleeding in Group 1, there was no significant difference between higher ACT values and lower ACT values (risk ratio [RR] for MACE, 1.16, 95% confidence interval [CI], 0.65-2.05, p=0.62, I(2)=94%, RR for major bleeding, 0.96, 95% CI, 0.66-1.40, p=0.83, I(2)=0%). Likewise, no significant difference was found in Group 2 between higher ACT values and lower ACT values (RR for MACE, 1.15, 95% CI, 0.97-1.35, p=0.10, I(2)=0%, RR for major bleeding, 0.85, 95% CI, 0.45-1.60, p=0.61, I(2)=83%). In conclusion, ACT may not have a substantial effect on thrombotic or hemorrhagic complications. Under current clinical practice, target ACT may be higher than what is necessary to prevent thrombotic events. We may achieve a relative low ACT level to preserve efficacy and enhance safety.
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