Abstract
To determine whether continuous preprocedural heparin influences the need for anticoagulation during percutaneous transluminal coronary angioplasty (PTCA), we compared heparin requirements in patients therapeutically anticoagulated after continuous heparinization for > or = 12 hours with patients not pretreated with heparin (controls). A Hemochron device was used to monitor the activated clotting time (ACT) values during the procedure. An ACT > or = 300 seconds was used as a measure of optimal anticoagulation. Patients pretreated with heparin had significantly higher preprocedural ACT measurements (163 +/- 31.5 vs 126 +/- 13 seconds, p < 0.001) and partial thromboplastin time (PTT) measurements (46 +/- 15 vs 25 +/- 3 seconds, p < 0.001) than controls. While the amount of heparin needed to achieve an initial ACT > 300 seconds was slightly greater in control patients (10,682 +/- 1,852 vs 9,269 +/- 2,993 units, p < 0.001), the total heparin required to maintain an ACT > 300 seconds throughout the procedure was similar between the two groups (11,551 +/- 3,181 units vs 12,136 +/- 2,575 units, p = NS). Thus preprocedural anticoagulation does not significantly reduce total heparin requirements, and these patients should receive the same initial heparin regimen as patients not pretreated with intravenous heparin.
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