Predictors of Initial Nontherapeutic Anticoagulation With Unfractionated Heparin in ST-Segment Elevation Myocardial Infarction
Key result
Weight-based unfractionated heparin dosing in STEMI patients resulted in only 33.8% achieving therapeutic initial aPTT, with markedly high aPTTs increasing bleeding risk (OR 2.11; P=0.004).
Why the study?
What are the predictors and clinical consequences of nontherapeutic anticoagulation with weight-based unfractionated heparin in STEMI patients?
Population
6,055 patients with ST-segment elevation myocardial infarction who received unfractionated heparin and a…
Design
Cohort, Patients in the main trial were randomized to enoxaparin or…
Follow-up
48 hours
Authors
Discussion
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Implication
Nontherapeutic aPTT with weight-based UFH in STEMI may heighten bleeding; hypothesis-generating for refined nomograms in older, female, or renally impaired patients.
Study Design
Type
RCT (n=6,055)
Randomization
randomized
Multicenter
Yes
Structured PICO
What are the predictors and clinical consequences of nontherapeutic anticoagulation with weight-based unfractionated heparin in STEMI patients?
P
Population
6,055 patients with ST-segment elevation myocardial infarction treated with unfractionated heparin and a fibrin-specific lytic who had an initial aPTT drawn within 4 to 8 hours.
I
Intervention
Unfractionated heparin dosed according to the American College of Cardiology/American Heart Association weight-based nomogram
O
Outcome
Proportion of initial aPTTs that were therapeutic (1.50 to 2.00 times control), markedly low (<1.25 times), or markedly high (≥2.75 times)surrogate
Despite using a standard weight-based nomogram, nontherapeutic anticoagulation with unfractionated heparin is frequent in STEMI patients, particularly in older, female, lower weight, and renal dysfunction patients, leading to increased bleeding or reinfarction risks.
Cite This Study
Cheng et al. (2009) conducted an RCT in ST-segment elevation myocardial infarction (n=6,055). Unfractionated heparin vs. Enoxaparin was evaluated on Therapeutic initial aPTT (1.50 to 2.00 times control). Weight-based unfractionated heparin dosing in STEMI patients resulted in only 33.8% achieving therapeutic initial aPTT, with markedly high aPTTs increasing bleeding risk (OR 2.11; P=0.004).