Revisiting optimal anticoagulation with unfractionated heparin during coronary stent implantation.
Using univariate and multivariate analyses, we evaluated the relation between ischemic and bleeding complications and peak procedural activated clotting time (ACT) in patients undergoing percutaneous coronary intervention whose coronary narrowings were treated with stent implantation. Of the 2,280 patients who qualified for the study, 29% had diabetes mellitus, and 91% received glycoprotein IIb/IIIa inhibitors. The median for ACT was 276 seconds (interquartile range 243 to 317). The incidence of ischemic events by ACT quartiles was 6.3%, 7.5%, 8.1%, and 7.1%, respectively (p=0.71). The incidence of bleeding complications was 6.6%, 5.9%, 6.9%, and 7.3%, respectively (p=0.81). ACT did not independently predict either ischemic or hemorrhagic complications.
Brener
Sorin J
SJ
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. breners@ccf.org
Bhatt
Deepak L
DL
Moliterno
David J
DJ
Schneider
Jakob P
JP
Ellis
Stephen G
SG
Topol
Eric J
EJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006406:Hematoma / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010314:Partial Thromboplastin Time; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012042:Registries; D012187:Retroperitoneal Space; D015607:Stents
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin