Use of bedside activated partial thromboplastin time monitor to adjust heparin dosing after thrombolysis for acute myocardial infarction: results of GUSTO-I. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.

Abstract

BACKGROUND:

The safety and efficacy of bedside monitors of activated partial thromboplastin time (aPTT) have not been examined in a large population receiving intravenous heparin after thrombolytic treatment for acute myocardial infarction. We compared outcomes among patients monitored with these devices versus standard monitoring methods.

METHODS AND RESULTS:

Investigators chose the bedside device (n = 1713 patients) or their standard method (n = 26,162) for all aPTT measurements at their sites. Clinical outcomes at 30 days, 1-year mortality rate, and aPTT levels at 6, 12, and 24 hours were compared. Bedside-monitored patients had significantly less moderate/severe bleeding (10% vs 12%, P < .01), fewer transfusions (7% vs 11%, P < .001), and a smaller decrease in hematocrit (5.5% vs 6.7%, P < .001) but significantly more recurrent ischemia (22% vs 20%, P = .01). Fewer bedside-monitored patients had subtherapeutic aPTT levels at 12 and 24 hours. Among patients with subtherapeutic levels at 6 and 12 hours, more bedside-monitored patients had therapeutic levels when next monitored. After adjustment for baseline differences, no significant difference in mortality rate was observed in bedside-monitored patients at 30 days (4.3% vs 4.8%, P = .27) and at 1 year (7.1% vs 7.7%, P = .38). The groups had similar rates of reinfarction, shock, heart failure, and stroke.

CONCLUSIONS:

This prospective substudy supports the use of bedside monitoring of heparin anticoagulation after thrombolysis.

• Authors: K M Zabel, C B Granger, R C Becker, E G Bovill, J Hirsh, P E Aylward, E J Topol, R M Califf
• Journal: American heart journal (Am Heart J) Vol. 136 Issue 5 Pg. 868-76 (Nov 1998) ISSN: 0002-8703 [Print] United States
• PMID: 9812083 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Heparin

Topics

• Aged
• Anticoagulants (administration & dosage)
• Confounding Factors, Epidemiologic
• Female
• Heparin (administration & dosage)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (drug therapy)
• Partial Thromboplastin Time
• Point-of-Care Systems
• Prospective Studies
• Thrombolytic Therapy
• Time Factors