title: Defining optimal activated clotting time for percutaneous coronary intervention: A systematic review and Bayesian meta-regression.
abstract: BACKGROUND
  Guidelines recommend routine monitoring of unfractionated heparin (UFH) with activated clotting time (ACT) during percutaneous coronary intervention (PCI). However, the optimal ACT for patients undergoing PCI is unclear.
  
  
  METHODS
  We sought to determine the association of peak ACT during PCI with 30-day major adverse cardiac events (MACE; all-cause mortality, myocardial infarction, and revascularization) and bleeding events. We searched the Cochrane Central Register of Controlled Trials, EMBASE, and Medline for randomized controlled trials (RCTs) evaluating UFH through May 2015. Only patients randomized to UFH alone or to UFH with a glycoprotein IIb/IIIa inhibitor (GPI) were analyzed using Bayesian meta-regression.
  
  
  RESULTS
  Among 13 included RCTs (n = 17455), eight (n = 5521) included study arms of UFH alone and 12 (n = 11934) included arms of UFH with a GPI. Peak ACT ranged from 201 to 460 sec for UFH alone and 248-317 sec for UFH with a GPI. With UFH alone, the probability of MACE was 7.0% (95% credible interval [CrI] 1.5, 31.5) for a peak ACT of 200 sec and 5.8% (95% CrI 2.6, 12.0) for 300 sec. Among UFH with a GPI, the probability of MACE was 2.8% (95% CrI 0.8, 6.8) for a peak ACT of 200 sec and 7.2% (95% CrI 5.4, 9.7) for 300 sec.
  
  
  CONCLUSIONS
  Among individual RCTs, the probability of MACE and major bleeding events associated with low versus high values of peak ACT is inconsistent. Our meta-regression results are inconclusive, emphasizing the need for RCTs comparing low versus high doses of UFH. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.|Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.|Department of Emergency Medicine, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mottillo
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.|Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.|Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Kristian B
authors.initials: KB
authors.lastname: Filion
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.|Division of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.|Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.|Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001499:Bayes Theorem; D001777:Blood Coagulation / Q000187:drug effects*; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin
keywords: activated clotting time; glycoprotein IIb/IIIa inhibitors; meta-regression; percutaneous coronary intervention; systematic review; unfractionated heparin