Defining the Optimal Activated Clotting Time During Percutaneous Coronary Intervention: Aggregate Results From 6 Randomized, Controlled Trials

摘要: Background —Unfractionated heparin has been the primary anticoagulant therapy for percutaneous coronary intervention >20 years. Despite availability of rapid “point care” testing, little clinical data defining optimal level anticoagulation are available. Furthermore, recent reports have advocated use low-dose regimens in absence large-scale, well-conducted studies to support this practice. Methods and Results —We pooled from 6 randomized, controlled trials novel adjunctive antithrombotic interventions which unfractionated constituted control arm. Patients were divided into 25-s intervals activated clotting times (ACTs), 476 s. In a total 5216 patients, incidence death, myocardial infarction, or any revascularization major minor bleeding at 7 days calculated each group compared. An ACT range 350 375 s provided lowest composite ischemic event rate 6.6%, 34% relative risk reduction 7-day events compared with rates observed between 171 295 by quartile analysis ( P =0.001). Conclusions —Contrary reports, suppression patients undergoing demands treatment levels that substantially higher than currently appreciated. These define goal dosing within establish benchmark against future can be