Activated Clotting Time Analysis in Elective Percutaneous Coronary Intervention Using Bolus and Continous Heparin at Dr. Saiful Anwar Hospital Malang
DOI:
https://doi.org/10.11594/jk-risk.05.1.4Keywords:
Activated Clotting Time, Heparin, Smoking, CHA2DS2-VAScAbstract
BACKGROUND: Unfractionated heparin effectively prevents thrombosis during percutaneous coronary intervention (IKP). Analysis between sex, age, BMI, diabetes, smoking, CHF, hypertension, stroke, lesion characteristics, CHA2DS2-VASc score, platelet, eGFR, and bleeding events with activated clotting time (ACT) achievement aims to elucidate the correlation in elective IKP procedures using heparin bolus administration followed by continuous heparin.
OBJECTIVE: To evaluate the relationship of sex, age, BMI, diabetes, smoking, CHF, hypertension, stroke, lesion characteristics, CHA2DS2-VASc score, platelet, eGFR, and bleeding events on achieving an ACT of ≥300 seconds in elective IKP patients at RSSA.
METHODS: This observational study analysed medical records of elective IKP patients at RSSA from July 2022 to August 2024. Data were collected via consecutive sampling. Univariate analysis described sample characteristics, while bivariate analysis assessed variable relationships. Logistic regression was used to develop a predictive model if significant variables was found.
RESULTS: Among 43 samples, 34.8% achieved ACT ≥300 seconds. No significant relationship was found among sex, age, BMI, diabetes, smoking, CHF, hypertension, stroke, lesion characteristics, CHA2DS2-VASc score, platelet, and eGFR (p=0.078; p=0.936; p=0.264; p=0.139; p=0.063; p=0.535; p=0.64; p=0.324; p=0.349: p=0.885; p=0.677; p=0.15 respectively). There is no bleeding event after procedure.
CONCLUSION: There is no relationship between variables sex, age, BMI, diabetes, smoking, CHF, hypertension, stroke, lesion characteristics, CHA2DS2-VASc score, platelet, and eGFR to ACT achievement in elective IKP patients receiving bolus and continuous heparin. Further research with larger sample sizes and standardized ACT measurements is recommended.
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References
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4. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(3):E18–114.
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6. Lee MS, Kong J. Heparin Physiology, and Clinical Application. 2015;16(3):189–99.
7. Hoebink M, Roosendaal LC, Beverloo MJ, Wiersema AM, van der Ploeg T, Steunenberg TAH, et al. Clinical Outcomes of 5000 IU Heparin Versus Activated Clotting Time–Guided Heparinization During Noncardiac Arterial Procedures: A Propensity Score Matched Analysis. J Endovasc Ther. 2024;00(X):1–10.
8. Deepak WB, George B, Christie B, Richard B, Michael B, Boden. Book Review: Opie’s Cardiovascular Drugs: A Companion to Braunwald’s Heart Disease. Elsevier. 2021;36(7):772–772.
9. Soleimannejad M, Aslanabadi N, Sohrabi B, Shamshirgaran M, Separham A, Kazemi B, et al. Activated clotting time level with weight based heparin dosing during percutaneous coronary intervention and its determinant factors. J Cardiovasc Thorac Res [Internet]. 2014;6(2):97–100. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25031824%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4097859
10. Kim TS, Kim SH, Kim BK, Kim JY, Kim JH, Jang SW, et al. Randomized Comparison of Continuous Versus Intermittent Heparin Infusion During Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol. 2016;2(3):319–26.
11. Hirsh J, Anand SS, Halperin JL, Fuster V. Guide to Anticoagulant Therapy : Heparin. Circulation. 2001;103(24):2994–3018.
12. Rath B, Bennett DH. Monitoring the effect of heparin by measurement of activated clotting time during and after percutaneous transluminal coronary angioplasty. Br Heart J. 1990;63(1):18–21.
13. Gallù M, Marrone G, Legramante JM, De Lorenzo A, Di Daniele N, Noce A. Female Sex as a Thromboembolic Risk Factor in the Era of Nonvitamin K Antagonist Oral Anticoagulants. Cardiovasc Ther. 2020;2020(1):1–9.
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15. Gigante, Bruna; Tamargo, Juan; Stefan, Agewall; Dan, Atar; Jurrien, ten Berg; Gianluca C et all. Update on Antithrombotic therapy and body mass. A Clinical Consensus Statement of the ESC Working Group on Cardiovascular Pharmacotherapy and the ESC Working Group on Thrombosis. Eur Hear J - Cardiovasc Pharmacother [Internet]. 2024;10(7):614–45. Available from: https://academic.oup.com/ehjcvp/advance-article/doi/10.1093/ehjcvp/pvae064/7750039
16. Toss H, Wallentin L, Siegbahn A. Influences of sex and smoking habits on anticoagulant activity in low- molecular-weight heparin treatment of unstable coronary artery disease. Am Heart J. 1999;137(1):72–8.
17. Li X, Weber NC, Cohn DM, Hollmann MW, Devries JH, Hermanides J, et al. Effects of hyperglycemia and diabetes mellitus on coagulation and hemostasis. J Clin Med. 2021;10(11):2419–33.
18. Roosendaal LC, Wiersema AM, Smit JW, Doganer O, Blankensteijn JD, Jongkind V. Editor’s Choice – Sex Differences in Response to Administration of Heparin During Non-Cardiac Arterial Procedures. Eur J Vasc Endovasc Surg [Internet]. 2022;64(5):557–65. Available from: https://doi.org/10.1016/j.ejvs.2022.08.005
19. Roth AR, Lazris A, Haskell H, James J. Lown Right Care Anticoagulation in Older Adults. Am Fam Physician www.aafp.org/afp [Internet]. 2020;101. Available from: www.mdcalc.com/cha2ds2-vasc-score-atrial-fibrillation-
20. Van Gelder IC, Rienstra M, Bunting K V, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;(00):1–101.
21. Ceyhun G. The relationship of the serum endocan level with the CHA2DS2-VASc score in patients with paroxysmal atrial fibrillation. Egypt Hear J [Internet]. 2021;73(1):9. Available from: https://doi.org/10.1186/s43044-021-00132-1
22. Reddy, PalemSumanth; Kumar, KondapakaKiran; Vanajakshamma V. Is CHA2DS2-VASc Score Useful in Predicting Atherosclerosis Burden? IOSR J Dent Med Sci. 2019;18(4):59–63.
23. Hayashi T. Do the Components of CHA2DS2-VAsc Score Affect Stroke Severity and Outcome? Circ J. 2016;80(1):74–5.
24. Tommasino A, Dell’Aquila F, Cesario V, Tempestini F, Casenghi M, Giovannelli F, et al. Multivessel disease in patient with acute myocardial infarction: current treatment strategies and future perspectives. Vessel Plus [Internet]. 2024;8:24. Available from: http://dx.doi.org/10.20517/2574-1209.2023.138
25. Ren H, Zheng Y, Hu X, Yang Y, Zhang Y, Sun Y, et al. High thrombus burden: a review of mechanisms and treatments. Int J Clin Exp Med. 2019;12(11):13068–78.
26. Spronk HMH, van der Voort D, ten Cate H. Blood coagulation and the risk of atherothrombosis: a complex relationship. Thromb J [Internet]. 2004;2(1):12. Available from: https://doi.org/10.1186/1477-9560-2-12
27. Gerlach A, Folino J, Morris B, Murphy C, Stawicki S, Cook C. Comparison of heparin dosing based on actual body weight in non-obese, obese and morbidly obese critically ill patients. Int J Crit Illn Inj Sci. 2013;3(3):195–9.
28. Qiu H, Jin L, Chen J, Shi M, Shi F, Wang M, et al. Comprehensive glycomic analysis reveals that human serum albumin glycation specifically affects the pharmacokinetics and efficacy of different anticoagulant drugs in diabetes. Diabetes. 2020;69(4):760–70.
29. Roosendaal LC, van Os TEK, van Es N, Hoebink M, Wiersema AM, Blankensteijn JD, et al. The Effect of Smoking on the Activated Clotting Time and the Incidence of Complications in Noncardiac Arterial Procedures. J Endovasc Ther [Internet]. 2023;00(0):1–8. Available from: https://doi.org/10.1177/15266028231207027
30. Tapson VF. The role of smoking in coagulation and thromboembolism in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005;2(1):71–7.
31. Liu Y, Yuan Z, Han X, Song K, Xing J. A Comparison of Activated Partial Thromboplastin Time and Activated Coagulation Time for Anticoagulation Monitoring during Extracorporeal Membrane Oxygenation Therapy. Hamostaseologie. 2021;43(3):171–8.
32. Grand’Maison A, Charest AF, Geerts WH. Anticoagulant Use in Patients with Chronic Renal Impairment. Am J Cardiovasc Drugs [Internet]. 2005;5(5):291–305. Available from: https://doi.org/10.2165/00129784-200505050-00002
33. Raschke RA, Reilly BM, Guidry JR, Fontana JR, Srinivas S. The weight-based heparin dosing nomogram compared with a standard care nomogram. Ann Intern Med [Internet]. 1993;119(9):874–81. Available from: http://www.annals.org/content/119/9/874.full
34. Dos Reis MacEdo LG, De Oliveira L, Pintão MC, Garcia AA, Pazin-Filho A. Error in body weight estimation leads to inadequate parenteral anticoagulation. Am J Emerg Med [Internet]. 2011;29(6):613–7. Available from: http://dx.doi.org/10.1016/j.ajem.2010.01.006
2. Badan Penelitian dan Pengembangan Kesehatan (Badan Litbangkes). Laporan Riskesdas 2018 Nasional.pdf. Lembaga Penerbit Balitbangkes. 2018. p. 674.
3. NADER E. AWAD, M.D. AFAEFMD., ASEM Sh. ABD EL KHALIQUE, M.Sc. JNRAMD. Calculatin the Effective Intravenous Heparin Dose: Comparison between Lean and Actual Body Weight-Based Dosing in Obese Patients. Med J Cairo Univ. 2020;88(6):1239–45.
4. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(3):E18–114.
5. Heestermans M, Poenou G, Hamzeh-Cognasse H, Cognasse F, Bertoletti L. Anticoagulants: A Short History, Their Mechanism of Action, Pharmacology, and Indications. Cells. 2022;11(20):1–17.
6. Lee MS, Kong J. Heparin Physiology, and Clinical Application. 2015;16(3):189–99.
7. Hoebink M, Roosendaal LC, Beverloo MJ, Wiersema AM, van der Ploeg T, Steunenberg TAH, et al. Clinical Outcomes of 5000 IU Heparin Versus Activated Clotting Time–Guided Heparinization During Noncardiac Arterial Procedures: A Propensity Score Matched Analysis. J Endovasc Ther. 2024;00(X):1–10.
8. Deepak WB, George B, Christie B, Richard B, Michael B, Boden. Book Review: Opie’s Cardiovascular Drugs: A Companion to Braunwald’s Heart Disease. Elsevier. 2021;36(7):772–772.
9. Soleimannejad M, Aslanabadi N, Sohrabi B, Shamshirgaran M, Separham A, Kazemi B, et al. Activated clotting time level with weight based heparin dosing during percutaneous coronary intervention and its determinant factors. J Cardiovasc Thorac Res [Internet]. 2014;6(2):97–100. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25031824%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4097859
10. Kim TS, Kim SH, Kim BK, Kim JY, Kim JH, Jang SW, et al. Randomized Comparison of Continuous Versus Intermittent Heparin Infusion During Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol. 2016;2(3):319–26.
11. Hirsh J, Anand SS, Halperin JL, Fuster V. Guide to Anticoagulant Therapy : Heparin. Circulation. 2001;103(24):2994–3018.
12. Rath B, Bennett DH. Monitoring the effect of heparin by measurement of activated clotting time during and after percutaneous transluminal coronary angioplasty. Br Heart J. 1990;63(1):18–21.
13. Gallù M, Marrone G, Legramante JM, De Lorenzo A, Di Daniele N, Noce A. Female Sex as a Thromboembolic Risk Factor in the Era of Nonvitamin K Antagonist Oral Anticoagulants. Cardiovasc Ther. 2020;2020(1):1–9.
14. Campbell NRC, Hull RD, Brant R, Hogan DB, Pineo GF, Raskob GE. Aging and Heparin-Related Bleeding. Arch Intern Med [Internet]. 1996 Apr 22;156(8):857–60. Available from: https://doi.org/10.1001/archinte.1996.00440080047006
15. Gigante, Bruna; Tamargo, Juan; Stefan, Agewall; Dan, Atar; Jurrien, ten Berg; Gianluca C et all. Update on Antithrombotic therapy and body mass. A Clinical Consensus Statement of the ESC Working Group on Cardiovascular Pharmacotherapy and the ESC Working Group on Thrombosis. Eur Hear J - Cardiovasc Pharmacother [Internet]. 2024;10(7):614–45. Available from: https://academic.oup.com/ehjcvp/advance-article/doi/10.1093/ehjcvp/pvae064/7750039
16. Toss H, Wallentin L, Siegbahn A. Influences of sex and smoking habits on anticoagulant activity in low- molecular-weight heparin treatment of unstable coronary artery disease. Am Heart J. 1999;137(1):72–8.
17. Li X, Weber NC, Cohn DM, Hollmann MW, Devries JH, Hermanides J, et al. Effects of hyperglycemia and diabetes mellitus on coagulation and hemostasis. J Clin Med. 2021;10(11):2419–33.
18. Roosendaal LC, Wiersema AM, Smit JW, Doganer O, Blankensteijn JD, Jongkind V. Editor’s Choice – Sex Differences in Response to Administration of Heparin During Non-Cardiac Arterial Procedures. Eur J Vasc Endovasc Surg [Internet]. 2022;64(5):557–65. Available from: https://doi.org/10.1016/j.ejvs.2022.08.005
19. Roth AR, Lazris A, Haskell H, James J. Lown Right Care Anticoagulation in Older Adults. Am Fam Physician www.aafp.org/afp [Internet]. 2020;101. Available from: www.mdcalc.com/cha2ds2-vasc-score-atrial-fibrillation-
20. Van Gelder IC, Rienstra M, Bunting K V, Casado-Arroyo R, Caso V, Crijns HJGM, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;(00):1–101.
21. Ceyhun G. The relationship of the serum endocan level with the CHA2DS2-VASc score in patients with paroxysmal atrial fibrillation. Egypt Hear J [Internet]. 2021;73(1):9. Available from: https://doi.org/10.1186/s43044-021-00132-1
22. Reddy, PalemSumanth; Kumar, KondapakaKiran; Vanajakshamma V. Is CHA2DS2-VASc Score Useful in Predicting Atherosclerosis Burden? IOSR J Dent Med Sci. 2019;18(4):59–63.
23. Hayashi T. Do the Components of CHA2DS2-VAsc Score Affect Stroke Severity and Outcome? Circ J. 2016;80(1):74–5.
24. Tommasino A, Dell’Aquila F, Cesario V, Tempestini F, Casenghi M, Giovannelli F, et al. Multivessel disease in patient with acute myocardial infarction: current treatment strategies and future perspectives. Vessel Plus [Internet]. 2024;8:24. Available from: http://dx.doi.org/10.20517/2574-1209.2023.138
25. Ren H, Zheng Y, Hu X, Yang Y, Zhang Y, Sun Y, et al. High thrombus burden: a review of mechanisms and treatments. Int J Clin Exp Med. 2019;12(11):13068–78.
26. Spronk HMH, van der Voort D, ten Cate H. Blood coagulation and the risk of atherothrombosis: a complex relationship. Thromb J [Internet]. 2004;2(1):12. Available from: https://doi.org/10.1186/1477-9560-2-12
27. Gerlach A, Folino J, Morris B, Murphy C, Stawicki S, Cook C. Comparison of heparin dosing based on actual body weight in non-obese, obese and morbidly obese critically ill patients. Int J Crit Illn Inj Sci. 2013;3(3):195–9.
28. Qiu H, Jin L, Chen J, Shi M, Shi F, Wang M, et al. Comprehensive glycomic analysis reveals that human serum albumin glycation specifically affects the pharmacokinetics and efficacy of different anticoagulant drugs in diabetes. Diabetes. 2020;69(4):760–70.
29. Roosendaal LC, van Os TEK, van Es N, Hoebink M, Wiersema AM, Blankensteijn JD, et al. The Effect of Smoking on the Activated Clotting Time and the Incidence of Complications in Noncardiac Arterial Procedures. J Endovasc Ther [Internet]. 2023;00(0):1–8. Available from: https://doi.org/10.1177/15266028231207027
30. Tapson VF. The role of smoking in coagulation and thromboembolism in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2005;2(1):71–7.
31. Liu Y, Yuan Z, Han X, Song K, Xing J. A Comparison of Activated Partial Thromboplastin Time and Activated Coagulation Time for Anticoagulation Monitoring during Extracorporeal Membrane Oxygenation Therapy. Hamostaseologie. 2021;43(3):171–8.
32. Grand’Maison A, Charest AF, Geerts WH. Anticoagulant Use in Patients with Chronic Renal Impairment. Am J Cardiovasc Drugs [Internet]. 2005;5(5):291–305. Available from: https://doi.org/10.2165/00129784-200505050-00002
33. Raschke RA, Reilly BM, Guidry JR, Fontana JR, Srinivas S. The weight-based heparin dosing nomogram compared with a standard care nomogram. Ann Intern Med [Internet]. 1993;119(9):874–81. Available from: http://www.annals.org/content/119/9/874.full
34. Dos Reis MacEdo LG, De Oliveira L, Pintão MC, Garcia AA, Pazin-Filho A. Error in body weight estimation leads to inadequate parenteral anticoagulation. Am J Emerg Med [Internet]. 2011;29(6):613–7. Available from: http://dx.doi.org/10.1016/j.ajem.2010.01.006
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How to Cite
Suprapta, A., & Widito, S. (2025). Activated Clotting Time Analysis in Elective Percutaneous Coronary Intervention Using Bolus and Continous Heparin at Dr. Saiful Anwar Hospital Malang. Jurnal Klinik Dan Riset Kesehatan, 5(1), 26-36. https://doi.org/10.11594/jk-risk.05.1.4
