Relationship Between Activated Clotting Time and Ischemic or Hemorrhagic Complications
Key result
ACT approaching 365 seconds during PCI is linked to increased bleeding but no fewer ischemic events.
- P=0.40 for trend
- n=8,369
Why the study?
Does higher activated clotting time (ACT) reduce ischemic complications or increase bleeding in patients undergoing PCI with unfractionated heparin?
Population
8,369 unfractionated heparin-treated patients undergoing percutaneous coronary intervention pooled from 4…
Comparison
Higher activated clotting time levels achieved… vs Lower activated clotting time (ACT) levels
Design
Cohort
Follow-up
48 hours
Authors
Discussion
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Implication
Higher ACT targets during PCI were not associated with fewer ischemic events but increased bleeding; leaves open whether lower targets improve net safety in trials.
Key Points
- The study aims to evaluate the relationship between activated clotting time (ACT) and the incidence of ischemic and hemorrhagic complications in patients receiving unfractionated heparin during PCI.
- Analyzed outcomes of UFH-treated patients from 4 large PCI trials
- Measured maximum ACT in 8369 out of 9974 eligible patients
- Assessed incidence of ischemic and bleeding events by ACT quartiles
- Ischemic complications showed no correlation with maximum ACT (P=0.29)
- Higher UFH doses increased bleeding events (OR 1.04 for each 10 U/kg, P=0.001)
- Minor bleeding trends increased with higher ACT, significant at P=0.04 for trend
Study Design
Type
Observational (n=8,369)
Multicenter
Yes
Structured PICO
Does higher activated clotting time (ACT) reduce ischemic complications or increase bleeding in patients undergoing PCI with unfractionated heparin?
P
Population
8,369 patients undergoing percutaneous coronary intervention treated with unfractionated heparin, evaluated for ischemic and bleeding complications at 48 hours.
E
Exposure
Higher activated clotting time (ACT) levels achieved with unfractionated heparin (UFH)
C
Comparator
Lower activated clotting time (ACT) levels
O
Outcome
Composite of death, myocardial infarction, or revascularization at 48 hourscomposite
Main Result
p-value: p=0.40 for trend
In patients undergoing PCI, higher ACT values do not reduce ischemic complications but are associated with increased bleeding risk, suggesting lower ACT targets may improve safety without compromising efficacy.
Cite This Study
Brener et al. (2004) conducted an observational in Percutaneous coronary intervention (n=8,369). Activated clotting time (ACT) vs. Lower ACT values was evaluated on Death, myocardial infarction, or revascularization at 48 hours (p=0.40 for trend). Maximal activated clotting time during PCI did not correlate with ischemic complications (P=0.40 for trend) but showed a linear increase in bleeding risk as ACT approached 365 seconds (P=0.01).