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The imprecision of measuring activated clotting time (ACT) from the guiding catheter during percutaneous coronary
Aviv Y Pollak1, Ofer M Kobo1, Gilad Margolis1
1Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.
Insights
Activated clotting time (ACT) measurements during percutaneous coronary intervention (PCI) from the guiding catheter are significantly higher than from the arterial sheath. This discrepancy may impact anticoagulation therapy and patient safety during PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) requires balancing ischemic event reduction and bleeding risk.
- Activated clotting time (ACT) is crucial for monitoring unfractionated heparin (UFH) anticoagulation during PCI.
Purpose of the Study:
- To evaluate the accuracy of ACT measurements obtained from the guiding catheter compared to the arterial access sheath during PCI.
Main Methods:
- Prospective enrollment of 331 patients undergoing PCI with UFH therapy.
- Simultaneous blood sampling for ACT from the coronary guide catheter and arterial access sheath.
- Analysis of ACT values and correlation with clinical variables.
Main Results:
- Mean ACT from the guiding catheter (294 ± 77 s) was significantly higher than from the arterial sheath (250 ± 60 s).
- A mean difference of 43 ± 27 s was observed between the two sampling sites (p < 0.001).
- In 30% of patients, guiding catheter ACT exceeded 250 s while sheath ACT was below 250 s; in 12%, guiding catheter ACT exceeded 200 s while sheath ACT was below 200 s.
Conclusions:
- A substantial proportion of patients may appear to have therapeutic ACT from the guiding catheter, while readings from the arterial sheath indicate subtherapeutic levels.
- This significant difference in ACT measurements between sampling sites during PCI warrants consideration for clinical and safety implications.
Background:
Finding the balance between the reduction in ischemic events and bleeding complications is crucial for the success of percutaneous coronary intervention (PCI). The activated clotting time (ACT) is used routinely worldwide to monitor and titrate anticoagulation therapy with unfractionated heparin (UFH) during the procedure.
Objectives:
We aimed to test the accuracy of ACT measurements from the guiding catheter compared to the arterial access sheath.
Methods:
Patients undergoing PCI with UFH therapy were prospectively enrolled. Blood samples were drawn from the coronary guide catheter and the arterial access sheath. ACT values were determined in the same ACT machine, and potential interactions with clinical variables were analyzed.
Results:
The study included 331 patients with post PCI ACT measurements. The mean ACT value of the catheter samples was statistically higher than the arterial access sample [294 ± 77 s Vs. 250 ± 60 s, p < 0.001]. The mean difference between the guiding catheter and the arterial line sheath samples was 43 ± 27 s (P < 0.001). We found that in 101/331 [30 %] patients the ACT from the guiding catheter was above 250 s, while from the access sheath it was below 250 s. Notably, in 40/331 [12 %] the ACT from the guiding catheter was above 200 s, while from the access sheath it was below 200 s.
Conclusions:
Large proportion of patient may be considered to have therapeutic ACT if measured from guide catheter during PCI, while the corresponding ACT from arterial sheath is subtherapeutic. This difference may have clinical and safety significance.
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