Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1990 Jan;63(1):18–21. doi: 10.1136/hrt.63.1.18

Monitoring the effect of heparin by measurement of activated clotting time during and after percutaneous transluminal coronary angioplasty.

B Rath 1, D H Bennett 1
PMCID: PMC1024308  PMID: 2178656

Abstract

The anticoagulant effect of heparin during percutaneous transluminal coronary angioplasty was monitored by measurements of the activated clotting time in two studies that compared the effects of a single bolus of heparin with those of a bolus of heparin combined with a continuous infusion of the drug. In a preliminary study 40 patients received a single heparin bolus of 10,000 units (protocol I) and a further 40 patients received both a heparin bolus of 10,000 and a continuous infusion of heparin at a rate of 2000 units per hour (protocol II). During the first 45 minutes, nine patients (23%) in protocol I but only two patients (5%) in protocol II were found to be inadequately anticoagulated. For 24 hours after angioplasty both groups received an infusion of heparin at the rate of 2000 units per hour which led to consistent anticoagulation in 73 (91%) of patients. In a subsequent randomised study, 40 patients received heparin according to either protocol I or II. Protocol II was again found to lead to a higher rate of adequate anticoagulation. During the first 60 minutes 11 patients (55%) in protocol I but only three patients (15%) in protocol II were inadequately anticoagulated. In addition, the activated clotting time of arterial blood in the first 30 minutes was significantly higher than that of venous blood in 70% of the patients. A bolus of heparin (10,000 units) together with an infusion of 2000 units per hour should be routinely given during coronary angioplasty. The effects of heparin, which can vary considerably from patient to patient, should be monitored by the measurement of the activated clotting time of arterial blood.

Full text

PDF
18

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Applegate R. J., Dell'Italia L. J., Crawford M. H. Usefulness of two-dimensional echocardiography during low-level exercise testing early after uncomplicated acute myocardial infarction. Am J Cardiol. 1987 Jul 1;60(1):10–14. doi: 10.1016/0002-9149(87)90974-x. [DOI] [PubMed] [Google Scholar]
  2. Bredlau C. E., Roubin G. S., Leimgruber P. P., Douglas J. S., Jr, King S. B., 3rd, Gruentzig A. R. In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty. Circulation. 1985 Nov;72(5):1044–1052. doi: 10.1161/01.cir.72.5.1044. [DOI] [PubMed] [Google Scholar]
  3. Bull B. S., Korpman R. A., Huse W. M., Briggs B. D. Heparin therapy during extracorporeal circulation. I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg. 1975 May;69(5):674–684. [PubMed] [Google Scholar]
  4. Clowes A. W., Clowes M. M. Kinetics of cellular proliferation after arterial injury. II. Inhibition of smooth muscle growth by heparin. Lab Invest. 1985 Jun;52(6):611–616. [PubMed] [Google Scholar]
  5. Estes J. W. Kinetics of the anticoagulant effect of heparin. JAMA. 1970 Jun 1;212(9):1492–1495. [PubMed] [Google Scholar]
  6. Gabliani G., Deligonul U., Kern M. J., Vandormael M. Acute coronary occlusion occurring after successful percutaneous transluminal coronary angioplasty: temporal relationship to discontinuation of anticoagulation. Am Heart J. 1988 Sep;116(3):696–700. doi: 10.1016/0002-8703(88)90326-2. [DOI] [PubMed] [Google Scholar]
  7. Hattersley P. G. Progress report: the activated coagulation time of whole blood (ACT). Am J Clin Pathol. 1976 Nov;66(5):899–904. doi: 10.1093/ajcp/66.5.899. [DOI] [PubMed] [Google Scholar]
  8. Hill J. D., Dontigny L., De Leval M., Mielke C. H., Jr A simple method of heparin management during prolonged extracorporeal circulation. Ann Thorac Surg. 1974 Feb;17(2):129–134. doi: 10.1016/s0003-4975(10)65621-4. [DOI] [PubMed] [Google Scholar]
  9. Hollman J., Gruentzig A. R., Douglas J. S., Jr, King S. B., 3rd, Ischinger T., Meier B. Acute occlusion after percutaneous transluminal coronary angioplasty--a new approach. Circulation. 1983 Oct;68(4):725–732. doi: 10.1161/01.cir.68.4.725. [DOI] [PubMed] [Google Scholar]
  10. Markwardt F., Klöcking H. P. Heparin-induced release of plasminogen activator. Haemostasis. 1977;6(6):370–374. doi: 10.1159/000214203. [DOI] [PubMed] [Google Scholar]
  11. OLSSON P., LAGERGREN H., EK S. The elimination from plasma of intravenous heparin. An experimental study on dogs and humans. Acta Med Scand. 1963 May;173:619–630. doi: 10.1111/j.0954-6820.1963.tb17446.x. [DOI] [PubMed] [Google Scholar]
  12. Park J. H., Bettmann M. A., Adelman B., Levin D. C., Miller R., Finkelstein J., Hunt M. In vivo imaging and evaluation of platelet accumulation vs. time at arterial injury site. Invest Radiol. 1985 May-Jun;20(3):287–292. doi: 10.1097/00004424-198505000-00011. [DOI] [PubMed] [Google Scholar]
  13. Schriever H. G., Epstein S. E., Mintz M. D. Statistical correlation and heparin sensitivity of activated partial thromboplastin time, whole blood coagulation time, and an automated coagulation time. Am J Clin Pathol. 1973 Sep;60(3):323–329. doi: 10.1093/ajcp/60.3.323. [DOI] [PubMed] [Google Scholar]
  14. Steele P. M., Chesebro J. H., Stanson A. W., Holmes D. R., Jr, Dewanjee M. K., Badimon L., Fuster V. Balloon angioplasty. Natural history of the pathophysiological response to injury in a pig model. Circ Res. 1985 Jul;57(1):105–112. doi: 10.1161/01.res.57.1.105. [DOI] [PubMed] [Google Scholar]
  15. Triplett D. A., Harms C. S., Koepke J. A. The effect of heparin on the activated partial thromboplastin time. Am J Clin Pathol. 1978 Sep;70(3 Suppl):556–559. [PubMed] [Google Scholar]
  16. Young J. A., Kisker C. T., Doty D. B. Adequate anticoagulation during cardiopulmonary bypass determined by activated clotting time and the appearance of fibrin monomer. Ann Thorac Surg. 1978 Sep;26(3):231–240. doi: 10.1016/s0003-4975(10)63676-4. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES