PMID- 22323092
OWN - NLM
STAT- MEDLINE
DCOM- 20121031
LR  - 20211021
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Linking)
VI  - 34
IP  - 1
DP  - 2012 Jul
TI  - Activated partial thromboplastin time measurement is not associated with clinical 
      outcomes in patients with high-risk non-ST-segment elevation acute coronary 
      syndromes treated with unfractionated heparin.
PG  - 114-9
LID - 10.1007/s11239-012-0693-y [doi]
AB  - Our objective was to determine the association of activated partial 
      thromboplastin time (aPTT) with recurrent ischemic events and non-coronary artery 
      bypass surgery-related thrombolysis in myocardial infarction major bleeding. We 
      studied 4,985 patients with high-risk non-ST-segment elevation acute coronary 
      syndromes (NSTE ACS) participating in SYNERGY, a prospective, randomized, 
      international trial designed to emulate contemporary practice wherein 
      unfractionated heparin (UFH) is given intravenously and titrated according to a 
      weight-adjusted dosing nomogram to a target aPTT of 1.5-2 times the upper limit 
      of normal (approximately 50-70 s). Aspirin was administered to 95% of patients, 
      clopidogrel to 63%, and glycoprotein IIb/IIIa receptor inhibitors to 58%. More 
      than 90% of patients underwent early coronary angiography, and 69% were 
      revascularized. Used as a time-dependent covariate, aPTT was evaluated as a 
      predictor of time to ischemic or major hemorrhagic events in proportional hazards 
      regression models. Using discrete variable analysis, aPTT was categorized as 
      persistently below a lower threshold of anticoagulation (<50 vs. >/=50 s) for 
      recurrent ischemic events and above an upper threshold (>70 vs. </=70 s) for major 
      hemorrhagic events. UFH treatment lasted a median of 42 (30, 78) h. At >6-12 (n = 
      3,021), >12-24 (n = 3,406), and >24-48 (n = 2,497) h, 34, 41, and 46% of patients 
      achieved the target aPTT range, respectively. Both before and after adjusting for 
      baseline predictors of anticoagulant response and risk score (age, hypertension, 
      diabetes, smoking, ST depression, and renal function), no significant 
      relationship between aPTT values and recurrent ischemic events or major bleeding 
      was found. No relationship was observed between clinical outcomes and aPTT values 
      persistently above or below the designated thresholds. Measurements of aPTT were 
      not associated with clinical outcomes among patients with NSTE ACS treated with 
      UFH. The required intensity of anticoagulation for benefit may be relatively 
      modest when UFH is administered concomitantly with dual or triple 
      platelet-directed therapy, particularly in patients undergoing early coronary 
      revascularization.
FAU - Thomas, Michael P
AU  - Thomas MP
AD  - Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA. 
      michptho@med.umich.edu
FAU - Mahaffey, Kenneth W
AU  - Mahaffey KW
FAU - Chiswell, Karen
AU  - Chiswell K
FAU - Cohen, Marc
AU  - Cohen M
FAU - Kontos, Michael C
AU  - Kontos MC
FAU - Antman, Elliott M
AU  - Antman EM
FAU - Ferguson, James J
AU  - Ferguson JJ
FAU - Califf, Robert M
AU  - Califf RM
FAU - Goodman, Shaun G
AU  - Goodman SG
FAU - Becker, Richard C
AU  - Becker RC
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Coronary Syndrome/*blood/complications/therapy
MH  - Aged
MH  - Aged, 80 and over
MH  - Angioplasty, Balloon, Coronary
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage
MH  - Hemorrhage/blood/drug therapy/etiology
MH  - Heparin/administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Partial Thromboplastin Time
MH  - Platelet Aggregation Inhibitors/administration & dosage
MH  - Predictive Value of Tests
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk Factors
EDAT- 2012/02/11 06:00
MHDA- 2012/11/01 06:00
CRDT- 2012/02/11 06:00
PHST- 2012/02/11 06:00 [entrez]
PHST- 2012/02/11 06:00 [pubmed]
PHST- 2012/11/01 06:00 [medline]
AID - 10.1007/s11239-012-0693-y [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2012 Jul;34(1):114-9. doi: 10.1007/s11239-012-0693-y.