title: Preprocedural anticoagulation does not reduce angioplasty heparin requirements.
abstract: To determine whether continuous preprocedural heparin influences the need for anticoagulation during percutaneous transluminal coronary angioplasty (PTCA), we compared heparin requirements in patients therapeutically anticoagulated after continuous heparinization for > or = 12 hours with patients not pretreated with heparin (controls). A Hemochron device was used to monitor the activated clotting time (ACT) values during the procedure. An ACT > or = 300 seconds was used as a measure of optimal anticoagulation. Patients pretreated with heparin had significantly higher preprocedural ACT measurements (163 +/- 31.5 vs 126 +/- 13 seconds, p < 0.001) and partial thromboplastin time (PTT) measurements (46 +/- 15 vs 25 +/- 3 seconds, p < 0.001) than controls. While the amount of heparin needed to achieve an initial ACT > 300 seconds was slightly greater in control patients (10,682 +/- 1,852 vs 9,269 +/- 2,993 units, p < 0.001), the total heparin required to maintain an ACT > 300 seconds throughout the procedure was similar between the two groups (11,551 +/- 3,181 units vs 12,136 +/- 2,575 units, p = NS). Thus preprocedural anticoagulation does not significantly reduce total heparin requirements, and these patients should receive the same initial heparin regimen as patients not pretreated with intravenous heparin.
authors: Johns Hopkins Medical Institution, Department of Medicine, Baltimore, MD 21287.
authors: R S
authors: RS
authors: Blumenthal
authors: M R
authors: MR
authors: Wolff
authors: J R
authors: JR
authors: Resar
authors: V J
authors: VJ
authors: Coombs
authors: J A
authors: JA
authors: Brinker
mesh_terms: D000789:Angina, Unstable / Q000188:drug therapy / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010314:Partial Thromboplastin Time; D011292:Premedication; D011446:Prospective Studies; D012044:Regression Analysis; D014914:Whole Blood Coagulation Time
chemical_list: D006493:Heparin