PMID- 27814785
OWN - NLM
STAT- MEDLINE
DCOM- 20170522
LR  - 20170522
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 119
IP  - 2
DP  - 2017 Jan 15
TI  - Effect of Fixed-Bolus (5,000 Units) Unfractionated Heparin Before Primary 
      Percutaneous Coronary Intervention on Activated Clotting Time, Time Flow, and 
      All-Cause Mortality.
PG  - 178-185
LID - S0002-9149(16)31611-3 [pii]
LID - 10.1016/j.amjcard.2016.09.039 [doi]
AB  - The American College of Cardiology Foundation /American Heart Association 
      guidelines recommend a weight-based dose of unfractionated heparin (UFH) for 
      primary percutaneous coronary intervention (PCI). However, it is convention to 
      administer a fixed-bolus dose of 5,000 units of UFH. It is unclear if 5,000 units 
      are sufficient to achieve a therapeutic first activated clotting time (ACT). We 
      conducted a retrospective cohort study to determine the proportion of therapeutic 
      first ACT in patients who received 5,000 units of UFH before primary PCI. We 
      examined the association of therapeutic first ACT with clinical outcomes, 
      including post-PCI Thombolysis in Myocardial Infarction (TIMI) grade flow, 
      myocardial infarction, bleeding, and mortality. Among the 269 included patients, 
      74.7% were men, and 61.4% were overweight or obese. The mean first ACT was 243.4 
      (SD = 61.5) seconds. Most patients (56.1%) had an infratherapeutic first ACT, 
      21.9% had a therapeutic first ACT, and 21.9% had a supratherapeutic first ACT. 
      Furthermore, 44.6% of patients who achieved the American College of Cardiology 
      Foundation/American Heart Association target weight-based dosing had an 
      infratherapeutic ACT. The proportion of patients with post-PCI TIMI grade flow 0 
      to 2 was 14.6% among those with a first ACT that was infratherapeutic versus 6.8% 
      among those with a first ACT that was not infratherapeutic (relative risk 2.15, 
      95% CI 0.99 to 4.65). In conclusion, over half of patients with ST-elevation 
      myocardial infarction administered 5,000 units of UFH have an infratherapeutic 
      first ACT and the high rate of poor TIMI grade flow in patients with an 
      infratherapeutic ACT is concerning.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Mottillo, Salvatore
AU  - Mottillo S
AD  - Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 
      McGill University, Montreal, Quebec, Canada; Department of Epidemiology, 
      Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, 
      Canada; 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; Department of Epidemiology, 
      Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, 
      Canada; 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; Division of Clinical Epidemiology, McGill 
      University Health Center, Montreal, Quebec, Canada.
FAU - Eberg, Maria
AU  - Eberg M
AD  - Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 
      McGill University, Montreal, Quebec, Canada.
FAU - Forgetta, Vincenzo
AU  - Forgetta V
AD  - Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 
      McGill University, Montreal, Quebec, Canada; Department of Epidemiology, 
      Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, 
      Canada.
FAU - Mancini, Joseph G
AU  - Mancini JG
AD  - Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 
      McGill University, 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; Department of Epidemiology, 
      Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, 
      Canada; Division of Cardiology, Jewish General Hospital, McGill University, 
      Montreal, Quebec, Canada; Division of Clinical Epidemiology, Jewish General 
      Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: 
      mark.eisenberg@mcgill.ca.
LA  - eng
PT  - Journal Article
DEP - 20161007
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Percutaneous Coronary Intervention
MH  - Retrospective Studies
MH  - ST Elevation Myocardial Infarction/blood/*mortality/*therapy
MH  - Treatment Outcome
MH  - Whole Blood Coagulation Time
EDAT- 2016/11/07 06:00
MHDA- 2017/05/23 06:00
CRDT- 2016/11/06 06:00
PHST- 2016/06/09 00:00 [received]
PHST- 2016/09/23 00:00 [revised]
PHST- 2016/09/23 00:00 [accepted]
PHST- 2016/11/07 06:00 [pubmed]
PHST- 2017/05/23 06:00 [medline]
PHST- 2016/11/06 06:00 [entrez]
AID - S0002-9149(16)31611-3 [pii]
AID - 10.1016/j.amjcard.2016.09.039 [doi]
PST - ppublish
SO  - Am J Cardiol. 2017 Jan 15;119(2):178-185. doi: 10.1016/j.amjcard.2016.09.039. 
      Epub 2016 Oct 7.