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Routine fixed-dose heparin vs. ACT-guided heparin administration for elective PCI and its influence on patient
Oron Berkowitz1, Majdi Halabi1,2, Alexander Goldberg1,2
1Azrieli Faculty of Medicine, Bar Ilan University.
Insights
Fixed-dose heparin (5000 IU) for percutaneous coronary intervention (PCI) without activated clotting time (ACT) monitoring is as safe as ACT-guided management. This approach may reduce procedure time in elective PCI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Society guidelines recommend activated clotting time (ACT)-based heparin dosing for percutaneous intervention (PCI).
- The impact of ACT monitoring on outcomes in elective PCI is not well-established.
- This study investigates the efficacy and safety of fixed-dose heparin versus ACT-guided management in elective PCI.
Purpose of the Study:
- To evaluate in-hospital outcomes of elective PCI patients receiving fixed-dose heparin without ACT measurement compared to those with ACT-guided management.
- To assess the safety profile, including major adverse cardiovascular events and bleeding complications, of both heparin dosing strategies.
- To determine if omitting ACT measurement in elective PCI impacts procedural efficiency.
Main Methods:
- Retrospective study of 500 consecutive elective PCI procedures between November 2015 and December 2018.
- Patients were divided into two groups: fixed-dose heparin (n=349) and ACT-guided heparin (n=151).
- Data collected included demographics, procedural details, and in-hospital outcomes (MACE, stent thrombosis, bleeding, access-related complications).
Main Results:
- Demographics and medical history were similar, though ACT group patients were younger and less likely to have prior coronary artery disease or kidney failure.
- The ACT group received higher total heparin doses and had longer procedure times (40.1 vs. 30.3 minutes).
- In-hospital outcomes, including major adverse cardiovascular events (1.1% vs. 1.3%), were rare and comparable between the groups.
Conclusions:
- A fixed-dose heparin (5000 IU) strategy for elective PCI, omitting ACT monitoring, results in similar in-hospital safety outcomes compared to ACT-guided management.
- This approach offers a potential advantage of slightly shortened procedural times.
- Fixed-dose heparin presents a viable alternative for anticoagulation in elective PCI, simplifying management without compromising patient safety.
Objective:
Activated clotting time (ACT)-based heparin dosing during percutaneous intervention (PCI) is recommended by Society guidelines. However, the relationship between ACT and outcome in the setting of elective PCI has not been sufficiently studied. We sought to evaluate the in-hospital outcome of patients undergoing elective PCI while receiving fixed-dose heparin without ACT measurement versus those with ACT-guided management.
Methods:
This retrospective study included consecutive patients undergoing elective PCI in a single-center between 11/2015 and 12/2018. Patients were divided into two groups, depending on whether ACT was measured. Heparin-only anticoagulation and non-femoral procedures were allowed. Patient demographics, procedural data and in-hospital outcomes were collected. The primary outcome was in-hospital major adverse cardiovascular events (MACE), secondary (safety) outcomes were in-hospital definite stent thrombosis, Bleeding Academic Research Consortium bleeding, access-related complications (any) as well as peri-procedural complications.
Results:
In total, 500 procedures were included in the study, 151 ACT and 349 fixed-dose. Patient demographics and medical history in both groups were well balanced, but those having ACTs were younger (63.2 ± 10.9 vs. 66.5 ± 11.3; P = 0.003) and less likely to have a history of coronary artery disease (74 vs. 82%; P = 0.032) or kidney failure. Procedural data were similar; however, total heparin dose and procedure length were higher in the ACT group (6232 ± 1388 vs.5032 ± 417 units; P < 0.001; 40.1 ± 14.0 vs. 30.3 ± 12.7 min; P < 0.001). Primary and secondary outcome events were rare and similar (MACE 1.1 vs. 1.3%; P = 0.86).
Conclusions:
A fixed-dose heparin injection (5000 IU) approach for elective PCI while omitting ACT offers slightly shortened procedural time and similar in-hospital safety profile.
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