Prognostic implication of activated partial thromboplastin time after reteplase or half-dose reteplase plus abciximab: results from the GUSTO-V trial.
OBJECTIVE
To evaluate the relationship between activated partial thromboplastin time (aPTT) and clinical outcomes in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-V) trial comparing standard-dose reteplase to half-dose reteplase and abciximab.


RESULTS
We analysed data on 11,420 patients receiving unfractionated heparin. Peak aPTT levels recorded during the hospitalization were correlated with clinical outcomes. Multivariable logistic regression models examined the relationship between peak aPTT levels and (i) moderate-to-severe bleeding, (ii) intracerebral haemorrhage, (iii) reinfarction, and (iv) 30-day mortality. Non-linear relationships were explored in the models using cubic spline functions. Higher rates of significant complications were seen in both groups when aPTT levels were <50 s or when levels were >70 s. In the combination therapy group, the relationship between aPTT levels and bleeding appeared accentuated. Reinfarction rates increased gradually as aPTT levels were >70 s in both groups, but the relationships were not statistically significant. Peak aPTT levels <50 s were associated with increased 30-day mortality even after multivariable adjustment.


CONCLUSIONS
Peak aPTT levels <50 s and >70 s are associated with worse clinical outcomes in the modern era of fibrinolytic therapy; these relationships are different in patients receiving standard reteplase vs. combination therapy.
Nallamothu
Brahmajee K
BK
University of Michigan Medical Center, Ann Arbor, MI, USA.
Bates
Eric R
ER
Hochman
Judith S
JS
Granger
Christopher B
CB
Guetta
Victor
V
Wilcox
Robert G
RG
White
Harvey D
HD
Armstrong
Paul W
PW
Savonitto
Stefano
S
Jia
Gang
G
Lincoff
A Michael
AM
Topol
Eric J
EJ
D000077284:Abciximab; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy / Q000401:mortality; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000925:Anticoagulants / Q000008:administration & dosage*; D002037:Bundle-Branch Block / Q000188:drug therapy / Q000401:mortality; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality; D023921:Coronary Stenosis / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D010314:Partial Thromboplastin Time / Q000401:mortality; D011994:Recombinant Proteins / Q000008:administration & dosage; D012008:Recurrence; D012044:Regression Analysis; D016019:Survival Analysis; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator; D000077284:Abciximab