Activated clotting time (ACT) values are used to guide anticoagulation therapy in percutaneous coronary interventions (PCI). Previous studies with heparin +/− glycoprotein inhibitors (GPI) have shown a correlation between higher ACT values and increased hemorrhagic complication rates. Our aim was to evaluate ACT results and hemorrhagic complications in patients who received bivalirudin +/− GPI while undergoing PCI.
Retrospective chart review of 316 patients undergoing PCI was conducted. The anticoagulants used were heparin +/− GPI or bivalirudin +/− GPI. Higher ACT values were defined as ≥ 300 seconds and lower ACT values were defined as < 300 seconds at end of procedure. Major bleeding included ≥ 3 gram drop in hemoglobin +/− transfusion, or retroperitoneal, gastrointestinal, or intracerebral bleeds. Minor bleeding included oozing at sheath site, hematoma, and bleeding which did not require transfusion. Major, minor, and total bleeds were compared to ACT values and analyzed to assess relationships.
Ninety-seven ACT values were obtained from 187 patients in the bivalirudin group, of which 53 (55%) were higher and 44 (45%) were lower. In the heparin group, fifty-four ACT values from 129 patients were obtained, all of which were lower. There were 10 major bleeds in the bivalirudin group (5.3%; ACTs: 3 higher, 3 lower, 4 unknown) and 4 in the heparin group (3.1%; ACTs: 0 higher,1 lower, 3 unknown). Additionally, five of the ten major bleeds occurred with concomitant GPI in the bivalirudin group compared to three of four in the heparin group. Twenty-one bleeds (11%) were documented in the bivalirudin group whereas there were 23 (18%) in the heparin group (p = 0.001), however the ACT value (higher versus lower) did not show significance (p = 0.771).CONCLUSIONS: Higher ACT values were not associated with increased bleeds in the bivalirudin group.
ACT values ≥ or < 300 did not appear to correlate with hemorraghic complications in bivalirudin patients undergoing PCI and may not be useful in adjusting anticoagulation strategies.
J.M. Martinez, None.