PMID- 38241058
OWN - NLM
STAT- MEDLINE
DCOM- 20240424
LR  - 20240503
IS  - 1473-5830 (Electronic)
IS  - 0954-6928 (Linking)
VI  - 35
IP  - 4
DP  - 2024 Jun 1
TI  - Platelet reactivity and activated clotting time predict hemorrhagic site 
      complications in patients with chronic coronary syndromes undergoing percutaneous 
      coronary interventions.
PG  - 292-298
LID - 10.1097/MCA.0000000000001336 [doi]
AB  - BACKGROUND: Radial access is preferred in patients with chronic coronary 
      syndromes (CCSs) treated with ad hoc percutaneous coronary intervention (PCI). 
      Antithrombotic and antiplatelet treatment before PCI may affect outcomes at 
      vascular access sites. QuikClot Radial is a kaolin-based band that may shorten 
      hemostasis time. Using point-of-care testing, we investigated the effect of 
      antithrombotic and antiplatelet treatment on access-site complications. METHODS: 
      This prospective observational study included consecutive patients with CCS on 
      chronic aspirin therapy referred for ad hoc PCI. The activated clotting time 
      (ACT), global thrombosis test and VerifyNow P2Y 12 test were done sequentially 
      after unfractionated heparin (UFH) and clopidogrel administration. Patients were 
      monitored for radial artery patency, bleeding and local hematoma until discharge. 
      RESULTS: We enrolled 40 patients [mean age, 68.8 +/- 8.8 years; men, 30 (75%)] who 
      received UFH (median dose, 8000 IU; interquartile range, 7000-9000 IU) and 
      clopidogrel (600 mg). All radial arteries remained patent during follow-up. Local 
      bleeding and hematomas were noted in 11 patients (27.5%) each. Patients with 
      bleeding had lower mean platelet activity at 2 h [122.5 +/- 51 platelet reactivity 
      units (PRU) vs. 158.7 +/- 43 PRU, P  = 0.04] and higher ACT (216.9 +/- 40 s vs. 
      184.6 +/- 28 s, P = 0.006) than patients without bleeding. An ACT >196 s at 2 h 
      predicted bleeding or hematoma (AUC, 0.72; 95% CI, 0.56-0.85, P = 0.008). 
      CONCLUSION: Lower platelet activity and higher ACT after PCI were associated with 
      higher bleeding risk at a vascular access site. Point-of-care testing of ACT 
      after the procedure may help identify patients with CCS undergoing PCI who are at 
      higher risk of access-site bleeding.
CI  - Copyright (c) 2024 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Ramotowski, Bogumil
AU  - Ramotowski B
AD  - Department of Cardiology, Centre of Postgraduate Medical Education, Warsaw, 
      Poland.
FAU - Lewandowski, Pawel
AU  - Lewandowski P
FAU - Slomski, Tomasz
AU  - Slomski T
FAU - Maciejewski, Pawel
AU  - Maciejewski P
FAU - Budaj, Andrzej
AU  - Budaj A
LA  - eng
SI  - ClinicalTrials.gov/NCT05336669
GR  - 501-1-10-14-20/21/Centre of Postgraduate Medical Education/
PT  - Journal Article
PT  - Observational Study
DEP - 20240122
PL  - England
TA  - Coron Artery Dis
JT  - Coronary artery disease
JID - 9011445
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Humans
MH  - Male
MH  - *Percutaneous Coronary Intervention/adverse effects/methods
MH  - Female
MH  - Aged
MH  - Prospective Studies
MH  - *Platelet Aggregation Inhibitors/therapeutic use/adverse effects
MH  - *Radial Artery
MH  - *Clopidogrel/adverse effects
MH  - Middle Aged
MH  - Whole Blood Coagulation Time
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects
MH  - Platelet Activation/drug effects
MH  - Chronic Disease
MH  - Hematoma/etiology/blood
MH  - Blood Coagulation/drug effects
MH  - Anticoagulants/adverse effects/therapeutic use
MH  - Aspirin/therapeutic use/adverse effects
MH  - Predictive Value of Tests
MH  - Vascular Patency
MH  - Risk Factors
MH  - Point-of-Care Testing
EDAT- 2024/01/19 12:44
MHDA- 2024/04/24 19:06
CRDT- 2024/01/19 11:34
PHST- 2024/04/24 19:06 [medline]
PHST- 2024/01/19 12:44 [pubmed]
PHST- 2024/01/19 11:34 [entrez]
AID - 00019501-990000000-00182 [pii]
AID - 10.1097/MCA.0000000000001336 [doi]
PST - ppublish
SO  - Coron Artery Dis. 2024 Jun 1;35(4):292-298. doi: 10.1097/MCA.0000000000001336. 
      Epub 2024 Jan 22.