Ferguson J J
Cardiology Research Department, St. Luke's Episcopal Hospital, Houston, TX 77225, USA.
Am Heart J. 1995 Sep;130(3 Pt 2):651-7. doi: 10.1016/0002-8703(95)90302-x.
Thrombus formation during percutaneous transluminal coronary angioplasty (PTCA) markedly increases the risk of abrupt closure, procedural failure, and major complications. Pretreatment with heparin may be beneficial in preventing procedural complications, although strategies for ensuring that patients have adequate anticoagulation have been the focus of considerable debate. Several studies have suggested a relationship between the development of PTCA complications and a low activated clotting time (ACT) or a low increase in ACT in response to heparin. Although there have been no prospective studies showing the superiority of any given threshold ACT over any other, current data support a recommendation that anticoagulation for patients undergoing PTCA be titrated to a HemoTec ACT of greater than 275 to 300 seconds or to a Hemochron ACT of greater than 350 to 400 seconds. Adjusting the heparin bolus dose according to body weight does not achieve a more predictable level of anticoagulation, although it may help avoid excessive anticoagulation in lighter-weight patients.
经皮腔内冠状动脉成形术（PTCA）期间形成血栓会显著增加急性血管闭塞、手术失败和严重并发症的风险。肝素预处理可能有助于预防手术并发症，尽管确保患者获得充分抗凝的策略一直是大量争论的焦点。几项研究表明，PTCA并发症的发生与活化凝血时间（ACT）较低或肝素诱导的ACT升高不足有关。虽然尚无前瞻性研究表明任何特定ACT阈值优于其他阈值，但现有数据支持一项建议，即对接受PTCA的患者进行抗凝治疗时，应将其调整至HemoTec ACT大于275至300秒或Hemochron ACT大于350至400秒。根据体重调整肝素推注剂量并不能实现更可预测的抗凝水平，尽管这可能有助于避免体重较轻患者出现过度抗凝。
