USE OF BEDSIDE ACTIVATED PARTIAL THROMBOPLASTIN TIME MONITOR TO ADJUST HEPARIN DOSING AFTER THROMBOLYSIS FOR ACUTE MYOCARDIAL-INFARCTION - RESULTS OF GUSTO-I

Background The safety and efficacy of bedside monitors of activated pa rtial thromboplastin time (aPTT) have not been examined in a large pop ulation receiving intravenous heparin after thrombolytic treatment for acute myocardial infarction. We compared outcomes among patients moni tored with these devices versus standard monitoring methods. Methods a nd Results investigators chose the bedside device (n = 1713 patients) or their standard method (n = 26,162) For all aPTT measurements at the ir sites. Clinical outcomes at 30 days, 1-year mortality rate, and aPT T levels at 6, 12, and 24 hours were compared. Bedside-monitored patie nts had significantly less moderate/severe bleeding (10% vs 12%, P < . 01), fewer transfusions (7% vs 11%, P < .001), and a smaller decrease in hematocrit (5.5% vs 6.7%, P < .001) but significantly more recurren t ischemia (22% vs 20%, P = .01). Fewer bedside-monitored patients had subtherapeutic aPTT levels at 12 and 24 hours. Among patients with su btherapeutic levels at 6 and 12 hours, more bedside-monitored patients had therapeutic levels when next monitored. After adjustment for base line differences, no significant difference in mortality rate was obse rved in bedside-monitored patients at 30 days (4.3% vs 4.8%, P = .27) and at 1 year(7.1% vs 7.7%, P = .38). The groups had similar rates of reinfarction, shock, heart failure, and stroke. Conclusions This prosp ective substudy supports the use of bedside monitoring of heparin anti coagulation after thrombolysis.