Catheterization and cardiovascular diagnosis
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Cathet Cardiovasc Diagn · Dec 1989
Adequate heparinization during PTCA: assessment using activated clotting times.
Heparinization during PTCA is often done empirically with an initial 10,000 unit bolus of heparin and subsequent additional boluses as deemed necessary to prevent thrombus formation and fibrin deposition. However, the initial 10,000 unit bolus may not result in adequate systemic anticoagulation in every patient, exposing some patients to risk of thrombus at the angioplasty site and subsequent reocclusion. In this non-randomized study, we assessed systemic coagulation during PTCA by retrospectively analyzing activated clotting times obtained in 108 consecutive patients. ⋯ Symptoms of stable or unstable angina had no significant effect on heparin requirement, although there was a trend toward greater heparin resistance in unstable angina. We conclude that it is important to monitor the status of anticoagulation during PTCA, for 11% of patients undergoing PTCA require additional initial heparin bolus to achieve an ACT greater than 300 seconds and to be effectively anticoagulated. Careful monitoring of heparinization during PTCA may reduce the incidence of thrombosis.