title: The effect of activated clotting time values for patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis.
abstract: Our aim was to illustrate the effect of higher activated clotting time (ACT) values versus lower ACT values on thrombotic or hemorrhagic events in coronary atherosclerotic heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI). PubMed, Embase, Web of Science, and Cochrane Library were searched. Observational studies assessing ACT related major adverse cardiac event (MACE) and major bleeding were included. Studies were allocated into three groups. Group 1 included studies with low percentage of participants prescribed with glycoprotein IIb/IIIa inhibitors ([GPI] ≤30%), Group 2 with high percentage of participants prescribed with GPI (>30%), and Group 3 with routine direct thrombin inhibitors (DTI) prescription. The cutoff is designed as 300s (290-310s) for Group 1, and 250s (240-260s) for Group 2. With regard to MACE and major bleeding in Group 1, there was no significant difference between higher ACT values and lower ACT values (risk ratio [RR] for MACE, 1.16, 95% confidence interval [CI], 0.65-2.05, p=0.62, I(2)=94%, RR for major bleeding, 0.96, 95% CI, 0.66-1.40, p=0.83, I(2)=0%). Likewise, no significant difference was found in Group 2 between higher ACT values and lower ACT values (RR for MACE, 1.15, 95% CI, 0.97-1.35, p=0.10, I(2)=0%, RR for major bleeding, 0.85, 95% CI, 0.45-1.60, p=0.61, I(2)=83%). In conclusion, ACT may not have a substantial effect on thrombotic or hemorrhagic complications. Under current clinical practice, target ACT may be higher than what is necessary to prevent thrombotic events. We may achieve a relative low ACT level to preserve efficacy and enhance safety.
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China.
authors.forename: Yi-Yue
authors.initials: YY
authors.lastname: Gui
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China.
authors.forename: Fang-Yang
authors.initials: FY
authors.lastname: Huang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China.
authors.forename: Bao-Tao
authors.initials: BT
authors.lastname: Huang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China.
authors.forename: Shi-Jian
authors.initials: SJ
authors.lastname: Chen
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China.
authors.forename: Xiao-Bo
authors.initials: XB
authors.lastname: Pu
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China.
authors.forename: Peng-Ju
authors.initials: PJ
authors.lastname: Wang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, China. Electronic address: hmaochen@vip.sina.com.
authors.forename: Mao
authors.initials: M
authors.lastname: Chen
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D019039:Platelet Glycoprotein GPIIb-IIIa Complex
keywords: Activated clotting time; Hemorrhage; Percutaneous coronary intervention; Thrombosis