PMID- 27545117
OWN - NLM
STAT- MEDLINE
DCOM- 20170327
LR  - 20181202
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 89
IP  - 3
DP  - 2017 Feb 15
TI  - Defining optimal activated clotting time for percutaneous coronary intervention: 
      A systematic review and Bayesian meta-regression.
PG  - 351-366
LID - 10.1002/ccd.26652 [doi]
AB  - BACKGROUND: Guidelines recommend routine monitoring of unfractionated heparin 
      (UFH) with activated clotting time (ACT) during percutaneous coronary 
      intervention (PCI). However, the optimal ACT for patients undergoing PCI is 
      unclear. METHODS: We sought to determine the association of peak ACT during PCI 
      with 30-day major adverse cardiac events (MACE; all-cause mortality, myocardial 
      infarction, and revascularization) and bleeding events. We searched the Cochrane 
      Central Register of Controlled Trials, EMBASE, and Medline for randomized 
      controlled trials (RCTs) evaluating UFH through May 2015. Only patients 
      randomized to UFH alone or to UFH with a glycoprotein IIb/IIIa inhibitor (GPI) 
      were analyzed using Bayesian meta-regression. RESULTS: Among 13 included RCTs 
      (n = 17455), eight (n = 5521) included study arms of UFH alone and 12 (n = 11934) 
      included arms of UFH with a GPI. Peak ACT ranged from 201 to 460 sec for UFH 
      alone and 248-317 sec for UFH with a GPI. With UFH alone, the probability of MACE 
      was 7.0% (95% credible interval [CrI] 1.5, 31.5) for a peak ACT of 200 sec and 
      5.8% (95% CrI 2.6, 12.0) for 300 sec. Among UFH with a GPI, the probability of 
      MACE was 2.8% (95% CrI 0.8, 6.8) for a peak ACT of 200 sec and 7.2% (95% CrI 5.4, 
      9.7) for 300 sec. CONCLUSION: Among individual RCTs, the probability of MACE and 
      major bleeding events associated with low versus high values of peak ACT is 
      inconsistent. Our meta-regression results are inconclusive, emphasizing the need 
      for RCTs comparing low versus high doses of UFH. (c) 2016 Wiley Periodicals, Inc.
CI  - (c) 2016 Wiley Periodicals, Inc.
FAU - Mottillo, Salvatore
AU  - Mottillo S
AD  - Center for Clinical Epidemiology, Lady Davis Institute, Jewish General 
      Hospital/McGill University, Montreal, Quebec, Canada.
AD  - Department of Epidemiology, Biostatistics, and Occupational Health, McGill 
      University, Montreal, Quebec, Canada.
AD  - Department of Emergency Medicine, McGill University Health Center, Montreal, 
      Quebec, Canada.
FAU - Filion, Kristian B
AU  - Filion KB
AD  - Center for Clinical Epidemiology, Lady Davis Institute, Jewish General 
      Hospital/McGill University, Montreal, Quebec, Canada.
AD  - Department of Epidemiology, Biostatistics, and Occupational Health, McGill 
      University, Montreal, Quebec, Canada.
AD  - Division of Clinical Epidemiology, Department of Medicine, McGill University, 
      Montreal, Quebec, Canada.
FAU - Joseph, Lawrence
AU  - Joseph L
AD  - Department of Epidemiology, Biostatistics, and Occupational Health, McGill 
      University, Montreal, Quebec, Canada.
AD  - Division of Clinical Epidemiology, McGill University Health Center, Montreal, 
      Quebec, Canada.
FAU - Eisenberg, Mark J
AU  - Eisenberg MJ
AD  - Center for Clinical Epidemiology, Lady Davis Institute, Jewish General 
      Hospital/McGill University, Montreal, Quebec, Canada.
AD  - Department of Epidemiology, Biostatistics, and Occupational Health, McGill 
      University, Montreal, Quebec, Canada.
AD  - Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill 
      University, Montreal, Quebec, Canada.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20160822
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Bayes Theorem
MH  - Blood Coagulation/*drug effects
MH  - Drug Monitoring/*methods
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/etiology
MH  - *Percutaneous Coronary Intervention/adverse effects/mortality
MH  - Platelet Aggregation Inhibitors/administration & dosage
MH  - Predictive Value of Tests
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Whole Blood Coagulation Time
OTO - NOTNLM
OT  - activated clotting time
OT  - glycoprotein IIb/IIIa inhibitors
OT  - meta-regression
OT  - percutaneous coronary intervention
OT  - systematic review
OT  - unfractionated heparin
EDAT- 2016/08/23 06:00
MHDA- 2017/03/28 06:00
CRDT- 2016/08/23 06:00
PHST- 2016/01/20 00:00 [received]
PHST- 2016/05/09 00:00 [revised]
PHST- 2016/06/04 00:00 [accepted]
PHST- 2016/08/23 06:00 [pubmed]
PHST- 2017/03/28 06:00 [medline]
PHST- 2016/08/23 06:00 [entrez]
AID - 10.1002/ccd.26652 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2017 Feb 15;89(3):351-366. doi: 10.1002/ccd.26652. 
      Epub 2016 Aug 22.