title: Use of bedside activated partial thromboplastin time monitor to adjust heparin dosing after thrombolysis for acute myocardial infarction: results of GUSTO-I. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.
abstract: BACKGROUND
  The safety and efficacy of bedside monitors of activated partial thromboplastin time (aPTT) have not been examined in a large population receiving intravenous heparin after thrombolytic treatment for acute myocardial infarction. We compared outcomes among patients monitored with these devices versus standard monitoring methods.
  
  
  RESULTS
  Investigators chose the bedside device (n = 1713 patients) or their standard method (n = 26,162) for all aPTT measurements at their sites. Clinical outcomes at 30 days, 1-year mortality rate, and aPTT levels at 6, 12, and 24 hours were compared. Bedside-monitored patients had significantly less moderate/severe bleeding (10% vs 12%, P < .01), fewer transfusions (7% vs 11%, P < .001), and a smaller decrease in hematocrit (5.5% vs 6.7%, P < .001) but significantly more recurrent ischemia (22% vs 20%, P = .01). Fewer bedside-monitored patients had subtherapeutic aPTT levels at 12 and 24 hours. Among patients with subtherapeutic levels at 6 and 12 hours, more bedside-monitored patients had therapeutic levels when next monitored. After adjustment for baseline differences, no significant difference in mortality rate was observed in bedside-monitored patients at 30 days (4.3% vs 4.8%, P = .27) and at 1 year (7.1% vs 7.7%, P = .38). The groups had similar rates of reinfarction, shock, heart failure, and stroke.
  
  
  CONCLUSIONS
  This prospective substudy supports the use of bedside monitoring of heparin anticoagulation after thrombolysis.
authors.affiliation: Mid-America Heart Institute, Kansas City, MO, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Zabel
authors.forename: C B
authors.initials: CB
authors.lastname: Granger
authors.forename: R C
authors.initials: RC
authors.lastname: Becker
authors.forename: E G
authors.initials: EG
authors.lastname: Bovill
authors.forename: J
authors.initials: J
authors.lastname: Hirsh
authors.forename: P E
authors.initials: PE
authors.lastname: Aylward
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010314:Partial Thromboplastin Time; D019095:Point-of-Care Systems; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D006493:Heparin