RESULTS OF A NATIONAL SURVEY ON ANTICOAGULATION FOR PTCA

In order to assess the current practice patterns in the United States for anticoagulation during PTCA, a survey was sent to the ACC membersh ip. A total of 377 surveys from physicians performing PTCA were tabula ted; 5 (1.3%) respondents performed < 20 PTCAs/year, 128 (34.0%) perfo rmed 20-75 PTCAs/year, 141 (37.4%) performed 75-150 PTCAs/year, 98 (26 .0%) performed > 150 PTCAs/year and 5 (1.3%) did not report their volu me. Seventy-eight (20.7%) were at university hospitals 153 (40.6%) wer e at other teaching hospitals, 142 (37.7%) were at non-teaching hospit als and 4 (1.1%) did not report their institutional affiliation. A tot al of 76.8% of respondents routinely started with a 10,000 U bolus of heparin, while only 3.2% of respondents used only a weight-adjusted he parin bolus. Fifty-nine percent of respondents routinely used intra-pr ocedure heparin infusions, usually 1000 U/hr. Anticoagulation monitori ng was used by 92.6% of respondents during PTCA, almost always activat ed clotting times (ACTs). Of the 335 physicians who used ACTs to guide heparin therapy during PTCA, 59.1% used the Hemochron device, 16.7% u sed the HemoTec device, and 24.2% did not know which machine they used . Lower volume operators and operators at non-teaching hospitals were more likely not to know the type of ACT machine used. Post-procedure h eparin infusions (usually titrated to an aPTT > 2 x control) were used by 70.3% of respondents. Lower volume operators were more likely to u se post-procedure heparin infusions. Thus, heparin therapy for PTCA co ntinues to be largely empiric, although the vast majority of cardiolog ists surveyed use ACT-guided heparin therapy for the procedure. Weight -based heparin dosing is still relatively uncommon. The usual target l evels of anticoagulation for PTCA are 300-350 seconds for Hemochron AC Ts and > 300 seconds for HemoTec ACTs. Despite the differences between ACT machines, a relatively large number of interventional cardiologis ts do not know which machine they use to assess and adjust intraproced ural anticoagulation.