Activated Partial Thromboplastin Time and Outcome After Thrombolytic Therapy for Acute Myocardial Infarction

Author:

Granger Christopher B.1,Hirsh Jack1,Califf Robert M.1,Col Jacques1,White Harvey D.1,Betriu Amadeo1,Woodlief Lynn H.1,Lee Kerry L.1,Bovill Edwin G.1,Simes R. John1,Topol Eric J.1

Affiliation:

1. From the Department of Medicine, Duke University Medical Center, Durham, NC (C.B.G., R.M.C., L.H.W., K.L.L.); McMaster University, Hamilton, Ontario, Canada (J.H.); Clinique Universitaire St Luc, Brussels, Belgium (J.C.); Green Lane Hospital, Auckland, New Zealand (H.D.W.); Hospital Clinic I Provincial de Barcelona, Barcelona, Spain (A.B.); University of Vermont, Burlington (E.G.B.); University of Sydney, Australia (R.J.S.); and Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).

Abstract

Background Although intravenous heparin is commonly used after thrombolytic therapy, few reports have addressed the relationship between the degree of anticoagulation and clinical outcomes. We examined the activated partial thromboplastin time (aPTT) in 29 656 patients in the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO-I) trial and analyzed the relationship between the aPTT and both baseline patient characteristics and clinical outcomes. Methods and Results Intravenous heparin was administered as a 5000-U bolus followed by an initial infusion of 1000 U/h, with dose adjustment to achieve a target aPTT of 60 to 85 seconds. aPTTs were collected 6, 12, and 24 hours after thrombolytic administration. Higher aPTT at 24 hours was strongly related to lower patient weight ( P <.00001) as well as older age, female sex, and lack of cigarette smoking (all P <.0001). At 12 hours, the aPTT associated with the lowest 30-day mortality, stroke, and bleeding rates was 50 to 70 seconds. There was an unexpected direct relationship between the aPTT and the risk of subsequent reinfarction. There was a clustering of reinfarction in the first 10 hours after discontinuation of intravenous heparin. Conclusions Although the relationship between aPTT and clinical outcome was confounded to some degree by the influence of baseline prognostic characteristics, aPTTs higher than 70 seconds were found to be associated with higher likelihood of mortality, stroke, bleeding, and reinfarction. These findings suggest that until proven otherwise, we should consider the aPTT range of 50 to 70 seconds as optimal with intravenous heparin after thrombolytic therapy.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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