The imprecision of measuring activated clotting time (ACT) from the guiding catheter during percutaneous coronary...

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.