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Association Between Maximal Activated Clotting Time and Major Bleeding Complications During Transradial
David W Louis1, Kevin Kennedy2, Fabio V Lima1
1Lifespan Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Insights
Higher activated clotting time (ACT) during transfemoral (TF) percutaneous coronary intervention (PCI) increases bleeding risk. However, elevated ACT does not appear to raise bleeding risk in transradial (TR) PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Elevated maximal activated clotting time (ACT) during transfemoral (TF) percutaneous coronary intervention (PCI) is linked to increased bleeding risk.
- The association between maximal ACT and bleeding risk in transradial (TR) PCI remains unclear.
Purpose of the Study:
- To investigate whether higher maximal ACT during TR PCI is associated with a greater risk of major bleeding.
- To compare the bleeding risk associated with maximal ACT in TR PCI versus TF PCI.
Main Methods:
- A retrospective analysis of 14,637 patients undergoing TR or TF PCI with unfractionated heparin monotherapy.
- Maximal ACT levels were categorized into tertiles.
- Multivariable logistic regression was used to assess the relationship between maximal ACT and major bleeding events, as well as composite outcomes.
Main Results:
- Major bleeding occurred more frequently with ACT >290 s versus ≤290 s after TF PCI (7.7% vs. 5.8%; p=0.006), but not after TR PCI (1.7% vs. 2.4%; p=0.18).
- Adjusted analysis confirmed a significantly higher major bleeding risk with ACT >290 s versus ≤290 s for TF PCI (OR: 1.28; 95% CI: 1.02-1.62; p=0.036), but not for TR PCI (OR: 0.72; 95% CI: 0.42-1.22; p=0.22).
- Maximal ACT was not associated with composite outcomes of in-hospital death, myocardial infarction, or stroke, or death, myocardial infarction, or urgent target vessel revascularization for either TF or TR PCI.
Conclusions:
- Higher maximal ACT is associated with a greater risk of major bleeding following TF PCI compared to TR PCI.
- The findings suggest that the threshold for acceptable ACT may differ between TF and TR PCI approaches.
Objectives:
This study sought to determine whether higher maximal activated clotting time (ACT) during transradial (TR) percutaneous coronary intervention (PCI) is associated with greater bleeding risk.
Background:
Higher maximal ACT during transfemoral (TF) PCI has been associated with a greater bleeding risk. It is unclear whether this relationship exists in the setting of TR PCI.
Methods:
Among 14,637 patients undergoing TR or TF PCI with unfractionated heparin monotherapy, the study related maximal ACT to the risk of major bleeding. In secondary analyses, the study related maximal ACT to composites of in-hospital death, myocardial infarction (MI), or stroke and in-hospital death, MI, or urgent target vessel revascularization. Multivariable logistic regression was employed to compare outcomes in the third with the first and second maximal ACT tertiles.
Results:
More major bleeding occurred at ACT >290 s versus ≤290 s following TF (7.7% vs. 5.8%; p = 0.006) but not TR PCI (1.7% vs. 2.4%; p = 0.18). After adjustment, major bleeding risk remained significantly higher at ACT >290 s versus ACT ≤290 s among TF (odds ratio: 1.28; 95% confidence interval: 1.02 to 1.62; p = 0.036) but not TR PCI (odds ratio: 0.72; 95% confidence interval: 0.42 to 1.22; p = 0.22). Maximal ACT was not related to the incidence of composite death, MI, or stroke or death, MI, or urgent target vessel revascularization following TF or TR PCI.
Conclusions:
Higher maximal ACT is associated with a greater risk of major bleeding following TF PCI than TR PCI.
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