Key result
Peak aPTT levels <50 s and >70 s were associated with worse clinical outcomes, including increased 30-day mortality for levels <50 s, in patients receiving fibrinolytic therapy.
Why the study?
Do peak aPTT levels outside the optimal range affect clinical outcomes in patients receiving unfractionated heparin and fibrinolytic therapy?
Cohort (n=11,420)
Yes
Do peak aPTT levels outside the optimal range affect clinical outcomes in patients receiving unfractionated heparin and fibrinolytic therapy?
In patients receiving fibrinolytic therapy and unfractionated heparin, peak aPTT levels outside the 50-70 seconds range are associated with worse clinical outcomes, including increased 30-day mortality for levels <50 s.
May inform aPTT targets in fibrinolysis; hypothesis-generating and should not yet change practice.
AIMS: To evaluate the relationship between activated partial thromboplastin time (aPTT) and clinical outcomes in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-V) trial comparing standard-dose reteplase to half-dose reteplase and abciximab. METHODS AND RESULTS: We analysed data on 11,420 patients receiving unfractionated heparin. Peak aPTT levels recorded during the hospitalization were correlated with clinical outcomes. Multivariable logistic regression models examined the relationship between peak aPTT levels and (i) moderate-to-severe bleeding, (ii) intracerebral haemorrhage, (iii) reinfarction, and (iv) 30-day mortality. Non-linear relationships were explored in the models using cubic spline functions. Higher rates of significant complications were seen in both groups when aPTT levels were <50 s or when levels were >70 s. In the combination therapy group, the relationship between aPTT levels and bleeding appeared accentuated. Reinfarction rates increased gradually as aPTT levels were >70 s in both groups, but the relationships were not statistically significant. Peak aPTT levels <50 s were associated with increased 30-day mortality even after multivariable adjustment. CONCLUSION: Peak aPTT levels <50 s and >70 s are associated with worse clinical outcomes in the modern era of fibrinolytic therapy; these relationships are different in patients receiving standard reteplase vs. combination therapy.
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Nallamothu et al. (2005) conducted a cohort in Occluded Coronary Arteries (n=11,420). Peak aPTT levels vs. Normal aPTT levels (50-70 s) was evaluated on moderate-to-severe bleeding, intracerebral haemorrhage, reinfarction, and 30-day mortality. Peak aPTT levels <50 s and >70 s were associated with worse clinical outcomes, including increased 30-day mortality for levels <50 s, in patients receiving fibrinolytic therapy.
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