Activated partial thromboplastin time measurement is not associated with clinical outcomes in patients with high-risk non-ST-segment elevation acute coronary syndromes treated with unfractionated heparin
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- 作者：Michael P. Thomas (18) michptho@med.umich.edu
Kenneth W. Mahaffey (1)
Karen Chiswell (1)
Marc Cohen (2)
Michael C. Kontos (3)
Elliott M. Antman (4)
James J. Ferguson (5)
Robert M. Califf (6)
Shaun G. Goodman (7)
Richard C. Becker (1) - 关键词：Activated partial thromboplastin time – ; Non ; ST ; segment elevation acute coronary syndromes – ; Unfractionated heparin – ; Bleeding
- 刊名：Journal of Thrombosis and Thrombolysis
- 出版年：2012
- 出版时间：July 2012
- 年：2012
- 卷：34
- 期：1
- 页码：114-119
- 全文大小：267.8 KB
- 参考文献：1. Anderson JL, Adams CD, Antman EM et al (2007) ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons; endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 50:e1–e157
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11. Mahaffey KW, Goodman SG (2006) Low-molecular-weight heparin vs unfractionated heparin in acute coronary syndromes—reply. JAMA 295:2353–2354 - 作者单位：1. Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA2. Newark Beth Israel Medical Center, 201 Lyons Avenue at Osborne Terrace, Newark, NJ 07112, USA3. VCU Pauley Heart Center, Virginia Commonwealth University, VCU Health System, PO Box 980036, Richmond, VA 23298, USA4. Brigham and Women鈥檚 Hospital, 75 Francis Street, Boston, MA 02115, USA5. AstraZeneca LP, 1800 Concord Pike, Wilmington, DE 19801, USA6. Duke Translational Medicine Institute, 200 Trent Drive, Durham, NC 27710, USA7. Canadian Heart Research Centre and Terrence Donnelly Heart Center, St. Michael鈥檚 Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada8. Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA
- 刊物类别：Medicine
- 刊物主题：Medicine & Public Health
Cardiology
Hematology - 出版者：Springer Netherlands
- ISSN：1573-742X
文摘
Our objective was to determine the association of activated partial thromboplastin time (aPTT) with recurrent ischemic events and non-coronary artery bypass surgery-related thrombolysis in myocardial infarction major bleeding. We studied 4,985 patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE ACS) participating in SYNERGY, a prospective, randomized, international trial designed to emulate contemporary practice wherein unfractionated heparin (UFH) is given intravenously and titrated according to a weight-adjusted dosing nomogram to a target aPTT of 1.5–2 times the upper limit of normal (approximately 50–70 s). Aspirin was administered to 95% of patients, clopidogrel to 63%, and glycoprotein IIb/IIIa receptor inhibitors to 58%. More than 90% of patients underwent early coronary angiography, and 69% were revascularized. Used as a time-dependent covariate, aPTT was evaluated as a predictor of time to ischemic or major hemorrhagic events in proportional hazards regression models. Using discrete variable analysis, aPTT was categorized as persistently below a lower threshold of anticoagulation (<50 vs. ≥50 s) for recurrent ischemic events and above an upper threshold (>70 vs. ≤70 s) for major hemorrhagic events. UFH treatment lasted a median of 42 (30, 78) h. At >6–12 (n = 3,021), >12–24 (n = 3,406), and >24–48 (n = 2,497) h, 34, 41, and 46% of patients achieved the target aPTT range, respectively. Both before and after adjusting for baseline predictors of anticoagulant response and risk score (age, hypertension, diabetes, smoking, ST depression, and renal function), no significant relationship between aPTT values and recurrent ischemic events or major bleeding was found. No relationship was observed between clinical outcomes and aPTT values persistently above or below the designated thresholds. Measurements of aPTT were not associated with clinical outcomes among patients with NSTE ACS treated with UFH. The required intensity of anticoagulation for benefit may be relatively modest when UFH is administered concomitantly with dual or triple platelet-directed therapy, particularly in patients undergoing early coronary revascularization.