RELATION BETWEEN PROCEDURAL ACTIVATED COAGULATION TIME AND OUTCOME AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Objectives. The purpose of this study was to determine whether a low p rocedural activated coagulation time is associated with a high rate of in hospital complications and to identify whether there is an activat ed coagulation time range that may be associated dth a low rate of com plications. Background. In recent years the activated coagulation time has come into widespread use for monitoring anticoagulation in the ca theterization laboratory. However, considerable controversy exists as to the standards by which to judge ''adequate'' anticoagulation for in terventional procedures. Methods. From a total of 1,469 consecutive pa tients with percutaneous transluminal coronary angioplasty, we retrosp ectively identified 103 (Group I, 7% of the overall population) with m ajor complications of death or emergency or urgent coronary artery byp ass graft surgery and compared them with 400 patients without complica tions (Group II), Group I patients had more high risk clinical charact eristics, such as type B and C lesions, class III and IV angina, recen t myocardial infarction and recent thrombo lytic treatment. Activated coagulation times were compared between Groups I and II at baseline, a fter administration of 10,000 U of heparin and at the end of the proce dure. Results. There were no differences in baseline activated coagula tion times between Groups I and II. Group I had significantly lower ac tivated coagulation times after heparin therapy and at the end of the procedure: 61% <250 s, 20% between 250 and 275 s, 11% between 275 and 300 s and 8% >300 s; 279 of Group II had activated coagulation times 2 7% <250 s, 17% between 250 and 275 s, 35% between 275 and 300 s and 21 % >300 s (p < 0.0001), Complications occurred in all patients with fin al activated coagulation times <250 s but in only 0.3% of patients wit h final activated coagulation times >300 s. Conclusions. A diminished activated coagulation time response to an initial bolus of heparin is associated with major in-hospital complications after coronary angiopl asty, although patients with complications did have a higher risk befo re the procedure. It remains to be determined whether there is an idea l ''target'' activated coagulation time for interventional procedures.