Determinants of Abnormal Activated Clotting Time in Cardiac Catheterisation

Objective: The systematic review aims to investigate the effect of sampling source on activated clotting time (ACT) measurement within cardiovascular surgery and cardiac catheterisation. It also examines the evidence surrounding novel clot assessment techniques and associated sampling variation. Methods: A comprehensive electronic search was conducted using PubMed, MEDLINE, Scopus, Cochrane database, and Google Scholar until 20th June 2020. All studies reporting sampling source variability of ACT in cardiac surgery, vascular surgery and cardiac catheterisation were included. Results: Fourteen studies were included in the systematic review. Inconsistent reports of variability were seen in cardiac surgery and cardiac catheterisation. There were no studies directly examining ACT variability in vascular surgery. Novel clot assessment techniques have been validated in cardiac surgery, but measurements vary depending on sampling source. Conclusion: Sampling source should be kept consistent to facilitate effective haemostatic strategies. More research is needed regarding variability in vascular surgery and novel clot assessment techniques.

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Activated Clotting Time as an Appropriate Test to Compare Heparin and Direct Thrombin Inhibitors Such as Hirudin or Ro 46-6240 in Experimental Arterial Thrombosis

Circulation ◽

10.1161/01.cir.91.5.1568 ◽

1995 ◽

Vol 91 (5) ◽

pp. 1568-1574 ◽

Cited By ~ 28

Author(s):

Jean Pierre Carteaux ◽

Alain Gast ◽

Thomas B. Tschopp ◽

Sébastien Roux

Keyword(s):

Arterial Thrombosis ◽

Thrombin Inhibitors ◽

Direct Thrombin Inhibitors ◽

Clotting Time ◽

Activated Clotting Time

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In Vitro Effects of the Platelet Glycoprotein IIb/IIIa Receptor Antagonist c7E3 Fab on the Activated Clotting Time

Circulation ◽

10.1161/01.cir.95.3.614 ◽

1997 ◽

Vol 95 (3) ◽

pp. 614-617 ◽

Cited By ~ 65

Author(s):

Tameshwar Ammar ◽

Lesley E. Scudder ◽

Barry S. Coller

Keyword(s):

Receptor Antagonist ◽

Platelet Glycoprotein ◽

Clotting Time ◽

Activated Clotting Time ◽

In Vitro Effects

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Variability of Activated Clotting Time by Site of Sample Draw During Percutaneous Coronary Intervention: A Prospective Single-Center Study

Angiology ◽

10.1177/0003319721992237 ◽

2021 ◽

pp. 000331972199223

Author(s):

Jacqueline H. Morris ◽

Junsoo Alex Lee ◽

Scott McNitt ◽

Ilan Goldenberg ◽

Craig R. Narins

Keyword(s):

Percutaneous Coronary Intervention ◽

Unfractionated Heparin ◽

Anticoagulation Therapy ◽

Coronary Intervention ◽

Clotting Time ◽

Access Sheath ◽

Arterial Blood ◽

Activated Clotting Time ◽

Guide Catheter ◽

Percutaneous Coronary

The activated clotting time (ACT) assay is used to monitor and titrate anticoagulation therapy with unfractionated heparin during percutaneous coronary intervention (PCI). Observations at our institution suggested a considerable difference between ACT values drawn from varying arterial sites, prompting the current study. Patients undergoing PCI with unfractionated heparin therapy were prospectively enrolled. Simultaneous arterial blood samples were drawn from the access sheath and the coronary guide catheter. Differences between Hemochron ACT values were determined, and potential interactions with clinical variables were analyzed. Immediately postprocedure, the simultaneous mean guide and sheath ACTs were 327 ± 62 seconds and 257 ± 44 seconds, respectively, with a mean difference of 70 ± 60 seconds (P < .001). Nearly all (90%) ACT values obtained via the guide catheter were higher than the concurrent ACT drawn from the sheath. Logistic regression analysis demonstrated that lower weight-adjusted heparin doses and absence of diabetes were associated with a greater difference between the ACT values. We conclude that the ACT value is substantially greater when assessed via the guide catheter versus the access sheath. Although the biological mechanisms require further study, this difference should be considered when managing anticoagulation during PCI and when reporting ACT as part of research protocols.

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