Prognostic value of post-procedural aPTT in patients with ST-elevation myocardial infarction treated with primary PCI

Wouter J. Kikkert; Sophie H. van Nes; Krystien V. V. Lieve; George D. Dangas; Jan van Straalen; Marije M. Vis; Jan Baan Jr; Karel T. Koch; Robbert J. de Winter; Jan J. Piek; Jan G. P. Tijssen; Jose P. Henriques

doi:10.1160/TH12-10-0726

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2013; 109(05): 961-970
DOI: 10.1160/TH12-10-0726

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Prognostic value of post-procedural aPTT in patients with ST-elevation myocardial infarction treated with primary PCI

Wouter J. Kikkert

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

Sophie H. van Nes

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

Krystien V. V. Lieve

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

George D. Dangas

²Cardiovascular Research Foundation, New York, New York, USA

³Mount Sinai Medical Center, New York, New York, USA

,

Jan van Straalen

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

Marije M. Vis

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

Jan Baan Jr

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

Karel T. Koch

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

Robbert J. de Winter

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

Jan J. Piek

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

Jan G. P. Tijssen

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

,

Jose P. Henriques

¹Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

› Author Affiliations

Abstract

Summary

Unfractionated heparin is the most commonly used anticoagulant in ST-elevation myocardial infarction (STEMI) and its effect can be monitored with activated partial thromboplastin time (aPTT). However, the optimal aPTT range during heparin therapy after primary percutaneous coronary intervention (PCI) is yet to be defined. A mean aPTT was calculated of all aPTT measurements in the first 24 hours after pPCI in a total of 1,876 STEMI patients. Mean aPTT measurements were stratified into four categories; < 1.5 times the upper limit of normal (ULN), 1.5 – 2.0 times ULN (the therapeutic group), 2.01 – 3.99 times ULN, and ≥ 4 times ULN. Compared to patients with a therapeutic aPTT, patients with aPTTs < 1.5 times ULN had no increase in recurrent ischaemic events and had similar rates of bleeding complications. Patients with a mean aPTT ≥ 4 times ULN had higher rates recurrent ischaemic and haemorrhagic complications. After multivariable analyses, aPTT ratios ≥ 4 times ULN were no longer associated with recurrent ischaemic events, but remained a strong predictor of severe and moderate bleeding (hazard ratio [HR] 4.64, p = 0.016 and HR 2.27, p = 0.052). In conclusion, in 1,876 STEMI patients treated with pPCI, low aPTTs in the first 24 hours after PCI were not associated with an increase in ischaemic events, whereas high aPTT values were associated with more frequent bleeding complications. These results indicate no clear benefit as well as a safety concern with heparin treatment after primary PCI.

Keywords

Acute myocardial infarction - heparins - intravascular devices

Full Text

References

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