PMID- 21833451
OWN - NLM
STAT- MEDLINE
DCOM- 20120208
LR  - 20110928
IS  - 2567-689X (Electronic)
IS  - 0340-6245 (Linking)
VI  - 106
IP  - 4
DP  - 2011 Oct
TI  - Suboptimal anticoagulation with pre-hospital heparin in ST-elevation myocardial 
      infarction.
PG  - 636-40
LID - 10.1160/TH11-04-0257 [doi]
AB  - This is a prospective, observational study performed in all consecutive 
      ST-elevation myocardial infarction (STEMI) patients who had activated clotting 
      time (ACT) measurement on arrival in the cathlab before coronary angiography. We 
      studied the therapeutic effects of a pre-hospital fixed heparin bolus dose in 
      consecutive patients with STEMI. A total of 1,533 patients received pre-hospital 
      administration of aspirin, high dose clopidogrel (600 mg) and a fixed bolus dose 
      of 5,000 IU unfractionated heparin (UFH), according to the national ambulance 
      protocols. Some patients were also treated with glycoprotein IIb/IIIa inhibitors 
      (GPI) in the ambulance. A therapeutic ACT range was defined according to the ESC 
      guidelines as 200-250 seconds when patients had GPI pre-treatment and 250-350 
      seconds when no GPI pre-treatment. Of the 1,533 patients, 216 patients (14.1%) 
      had an ACT within the therapeutic range, 82.3% of the patients had a too low ACT, 
      whereas 3.5% of the patients had a too high ACT. After multivariable analysis, 
      the only independent predictor of a too low ACT was increasing weight (odds ratio 
      1.02/kg, 95% confidence interval 1.01-1.03, p=0.001). Patients with a too low ACT 
      had less often an open infarct related vessel (initial TIMI flow 2,3) as compared 
      to patients with an ACT in range (36.5% vs. 45.9%, p=0.013). In only a minority 
      of patients with STEMI, pre-hospital treatment with a fixed bolus dose UFH is 
      within the therapeutic ACT range. Increased weight is an independent determinant 
      of a too low ACT. We strongly recommend weight adjusted administration of UFH in 
      the ambulance.
FAU - Hermanides, Renicus S
AU  - Hermanides RS
AD  - Isala Klinieken, Department of Cardiology, Groot Wezenland 20, 8011JW Zwolle, The 
      Netherlands.
FAU - Ottervanger, Jan Paul
AU  - Ottervanger JP
FAU - Dambrink, Jan-Henk E
AU  - Dambrink JH
FAU - de Boer, Menko-Jan
AU  - de Boer MJ
FAU - Hoorntje, Jan C A
AU  - Hoorntje JC
FAU - Gosselink, A T Marcel
AU  - Gosselink AT
FAU - Suryapranata, Harry
AU  - Suryapranata H
FAU - Zijlstra, Felix
AU  - Zijlstra F
FAU - van 't Hof, Arnoud W J
AU  - van 't Hof AW
CN  - Zwolle Myocardial Infarction Study Group
LA  - eng
PT  - Journal Article
DEP - 20110811
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - *Body Weight
MH  - Diagnostic Tests, Routine/methods
MH  - Drug Dosage Calculations
MH  - Electrocardiography
MH  - Emergency Medical Services
MH  - Female
MH  - Heparin/administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*diagnosis/drug therapy/physiopathology
MH  - Practice Guidelines as Topic
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Prospective Studies
MH  - *Whole Blood Coagulation Time
EDAT- 2011/08/13 06:00
MHDA- 2012/02/09 06:00
CRDT- 2011/08/12 06:00
PHST- 2011/04/20 00:00 [received]
PHST- 2011/07/08 00:00 [accepted]
PHST- 2011/08/12 06:00 [entrez]
PHST- 2011/08/13 06:00 [pubmed]
PHST- 2012/02/09 06:00 [medline]
AID - 11-04-0257 [pii]
AID - 10.1160/TH11-04-0257 [doi]
PST - ppublish
SO  - Thromb Haemost. 2011 Oct;106(4):636-40. doi: 10.1160/TH11-04-0257. Epub 2011 Aug 
      11.