Results of a national survey on anticoagulation for PTCA.
In order to assess the current practice patterns in the United States for anticoagulation during PTCA, a survey was sent to the ACC membership. A total of 377 surveys from physicians performing PTCA were tabulated; 5 (1.3%) respondents performed < 20 PTCAs/year, 128 (34.0%) performed 20-75 PTCAs/year, 141 (37.4%) performed 75-150 PTCAs/year, 98 (26.0%) performed > 150 PTCAs/year and 5 (1.3%) did not report their volume. Seventy-eight (20.7%) were at university hospitals 153 (40.6%) were at other teaching hospitals, 142 (37.7%) were at non-teaching hospitals and 4 (1.1%) did not report their institutional affiliation. A total of 76.8% of respondents routinely started with a 10,000 U bolus of heparin, while only 3.2% of respondents used only a weight-adjusted heparin bolus. Fifty-nine percent of respondents routinely used intra-procedure heparin infusions, usually 1000 U/hr. Anticoagulation monitoring was used by 92.6% of respondents during PTCA, almost always activated clotting times (ACTs). Of the 335 physicians who used ACTs to guide heparin therapy during PTCA, 59.1% used the Hemochron device, 16.7% used the HemoTec device, and 24.2% did not know which machine they used. Lower volume operators and operators at non-teaching hospitals were more likely not to know the type of ACT machine used. Post-procedure heparin infusions (usually titrated to an aPTT > 2 x control) were used by 70.3% of respondents. Lower volume operators were more likely to use post-procedure heparin infusions. Thus, heparin therapy for PTCA continues to be largely empiric, although the vast majority of cardiologists surveyed use ACT-guided heparin therapy for the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
Ferguson
J J
JJ
St. Luke's Episcopal Hospital, Houston, TX 77225, USA.
Dohmen
P
P
Wilson
J M
JM
Vaughn
W K
WK
Khoshnevis
R
R
Kmonicek
P
P
McKinney
A A
AA
Plachetka
J R
JR
D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000706:statistics & numerical data; D000925:Anticoagulants / Q000008:administration & dosage*; D001780:Blood Coagulation Tests / Q000295:instrumentation; D003625:Data Collection; D006493:Heparin / Q000008:administration & dosage*; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D010818:Practice Patterns, Physicians'; D014481:United States; D014914:Whole Blood Coagulation Time