Li Jingyi, Liu Zhenyu, Zhang Shuyang, Shen Zhujun, Fan Zhongjie, Zeng Yong, Xie Hongzhi, Wang Chonghui, Jin Xiaofeng, Fang Quan, Zhu Wenling
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China.
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China; Email:
Zhonghua Xin Xue Guan Bing Za Zhi. 2015 May;43(5):408-12.
To investigate the activated clotting time (ACT) level after administration of guideline-recommended dose of unfractionated heparin (UFH) and to confirm the importance of ACT monitoring in percutaneous coronary intervention (PCI).
We performed a retrospective study on 1 062 patients undergoing elective PCI in Peking Union Medical College Hospital from May 1, 2011 to December 31, 2012. All patients were administrated weight-adjusted UFH (70-100 U/kg) based on PCI guideline of ACCF/AHA/SCAI. Patients were divided into 3 groups: ACT < 300 s (598 cases), ACT 300-350 s (183 cases) and ACT > 350 s (281 cases). ACT level and factors that may affect UFH anticoagulation were analyzed.
(1) The mean age was (63.0 ± 10.6) years and 751 (70.7%) patients were men. The mean weight was (70.5 ± 11.7) kg, and the mean UFH dose used was (100.7 ± 9.1) U/kg. (2) The median ACT was 285 (240-352) s after the UFH use. Pre-defined ACT target (300-350 s) was achieved only in 17.2% (183/1 062) patients. (3) Age, gender, height, weight, UFH/weight and the risk factors of coronary heart disease were similar among 3 groups (all P > 0.05). Multifactor linear correlation analysis showed that UFH/weight was related to ACT level (r = 0.07, P < 0.01), but other factors were not related to ACT level (all P > 0.05). (4) Among 598 patients with ACT < 300 s, 444 (74.2%) patients received additional UFH. No major bleeding events were observed in 1 062 patients. The incidence of minor bleeding and ischemic complications within 48 h after procedure were similar among 4 groups of ACT < 300 s with additional UFH, ACT < 300 s without additional UFH, ACT 300-350 s and ACT > 350 s (all P > 0.05).
In this single-center study, only a small proportion of patients reached the ACT target after administration of weight-adjusted UFH. Our results supported the recommendation of ACT monitoring in current PCI guideline to improve efficacy and safety of UFH anticoagulation therapy.
研究按指南推荐剂量给予普通肝素（UFH）后的活化凝血时间（ACT）水平，并证实ACT监测在经皮冠状动脉介入治疗（PCI）中的重要性。
我们对2011年5月1日至2012年12月31日在北京协和医院接受择期PCI的1062例患者进行了一项回顾性研究。所有患者均根据美国心脏病学会基金会/美国心脏协会/心血管造影和介入学会（ACCF/AHA/SCAI）的PCI指南给予体重调整后的UFH（70 - 100 U/kg）。患者分为3组：ACT < 300秒（598例）、ACT 300 - 350秒（183例）和ACT > 350秒（281例）。分析ACT水平及可能影响UFH抗凝的因素。
（1）平均年龄为（63.0 ± 10.6）岁，751例（70.7%）患者为男性。平均体重为（70.5 ± 11.7）kg，平均使用的UFH剂量为（100.7 ± 9.1）U/kg。（2）使用UFH后ACT的中位数为285（240 - 352）秒。仅17.2%（183/1062）的患者达到预先设定的ACT目标（300 - 350秒）。（3）3组患者的年龄、性别、身高、体重、UFH/体重及冠心病危险因素相似（均P > 0.05）。多因素线性相关分析显示UFH/体重与ACT水平相关（r = 0.07，P < 0.01），但其他因素与ACT水平无关（均P > 0.05）。（4）在ACT < 300秒的598例患者中，444例（74.2%）患者接受了额外的UFH。1062例患者中未观察到重大出血事件。ACT < 300秒且接受额外UFH、ACT < 300秒且未接受额外UFH、ACT 300 - 350秒和ACT > 350秒这4组患者术后48小时内轻微出血和缺血性并发症的发生率相似（均P > 0.05）。
在这项单中心研究中，给予体重调整后的UFH后仅有一小部分患者达到ACT目标。我们的结果支持当前PCI指南中关于ACT监测的建议，以提高UFH抗凝治疗的有效性和安全性。
