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Mean Activated Clotting Time of Patients Receiving Intravenous Heparin and Undergoing Primary Percutaneous Coronary

Abdul R Solangi1, Ahmed Wahab2, Abdul R Ansari2

  • 1Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK.

Cureus
|April 25, 2024
PubMed

Insights

This study found no clear link between activated clotting time (ACT) and bleeding or infarct risks during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). Further research into bleeding risk models is recommended.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Thrombosis Management

Background:

  • Acute myocardial infarction (AMI) remains a leading cause of mortality.
  • Primary percutaneous coronary intervention (PPCI) is the standard treatment for ST-segment elevation myocardial infarction (STEMI).
  • Current anticoagulation strategies, like unfractionated heparin, require optimization for PCI procedures.

Purpose of the Study:

  • To investigate the association between mean activated clotting time (ACT) and the incidence of bleeding and ischemic events in STEMI patients undergoing PPCI.
  • To evaluate the adequacy of current anticoagulation monitoring during PPCI.

Main Methods:

  • A one-year prospective observational study conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
  • Measurement of activated clotting time (ACT) before and after PPCI in STEMI patients.
  • Analysis of the correlation between ACT values and post-procedural bleeding and infarct complications.

Main Results:

  • The study included a majority of male patients (70.15%) with a mean age of 56.08 years.
  • Post-PPCI ACT ranged from 255 to 453 seconds (mean 350.56 ± 39.62s), lower than pre-PPCI values (mean 504.15 ± 38.98s).
  • Higher ACT was observed in female, smoker, and overweight patients; no significant difference was found in hypertensive or dyslipidemic patients.

Conclusions:

  • The observed ACT range (255-453s) did not show a significant relationship with bleeding or ischemic complications in STEMI patients undergoing PPCI.
  • Current ACT monitoring may not be sufficient to predict adverse outcomes.
  • Improved and validated bleeding risk models are necessary for better patient risk stratification prior to PCI.

Keywords:
activated clotting timeanticoagulant therapyheparinpercutaneous coronary interventionst-elevation myocardial infarction (stemi)

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