[The use of activated clotting time (ACT) to optimize heparinization during coronary angioplasty. The nursing personnel of the Hemodynamics Laboratory].
BACKGROUND
Suboptimal anticoagulation during coronary angioplasty is reported to be a major risk factor for occlusive complications.


OBJECTIVE
To define an appropriate timing for activated clotting time (ACT) tests in order to optimize anticoagulation with heparin during coronary angioplasty.


METHODS
In 50 consecutive procedures of elective angioplasty ACT was measured at baseline, at 30, 60 and 120 min after heparin 10,000 U iv. In a subgroup of 25 patients (SG1) no additional heparin was given until the ACT test at 60 min. In a second subgroup of 25 patients (SG2) heparin 5,000 U was administered 30-45 min after the initial bolus if the ACT at 30 min was < 300 sec. ACT values were analyzed, and the correlation with the biological variables of patients was tested.


RESULTS
In 20 patients out of 50 (40%) ACT values at 30 min were < 275 min. Heparin response was correlated with the body surface area but nor with age, neither with baseline ACT. Values at 60 min showed an adequate anticoagulation in only 6 patients (24%) in SG1 vs 21 (84%) in SG2. There were not complications.


CONCLUSIONS
ACT testing 30 min after heparin 10,000 U during coronary angioplasty identifies most patients requiring early supplemental heparin. This yields an adequate anticoagulation at 60 min in most patients.
Dellavalle
A
A
Laboratorio di Emodinamica e Divisione di Cardiologia, Ospedale Santa Croce, Cuneo.
Steffenino
G
G
Ribichini
F
F
Russo
P
P
Conte
L
L
Conte
E
E
Uslenghi
E
E
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000706:statistics & numerical data; D001777:Blood Coagulation / Q000187:drug effects; D016009:Chi-Square Distribution; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014914:Whole Blood Coagulation Time
D006493:Heparin
Uso dell'activated clotting time (ACT) per ottimizzare l'eparinizzazione in corso di angioplastica coronarica. Il personale infermieristico del Laboratorio di Emodinamica.