Published Online
on June 9, 2003

A more recent version of this article appeared on June 17, 2003

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Submitted on December 17, 2002
Revised on March 25, 2003
Accepted on March 26, 2003

Relationship of Activated Partial Thromboplastin Time to Coronary Events and Bleeding in Patients With Acute Coronary Syndromes Who Receive Heparin

Sonia S. Anand MD, MSc, FRCP(c)^*, Salim Yusuf DPhil, FRCP, Janice Pogue MSc, Jeffrey S. Ginsberg MD, FRCP(c), Jack Hirsh MD, FRCP(c), and on Behalf of the Organization to Assess Strategies for Ischemic Syndromes (OASIS) Investigators

From the Population Health Research Institute (S.S.A., S.Y., J.P.) and Henderson Research Centre (J.S.G., J.H.), McMaster University, Hamilton, Canada, and the Divisions of Cardiology and Thrombosis, Department of Medicine (S.S.A., S.Y., J.P., J.S.G., J.H.), McMaster University, Hamilton, Canada.

^* To whom correspondence should be addressed. E-mail: anands{at}mcmaster.ca.

Background--Antithrombotic therapy with intravenous heparin in conjunction with aspirin reduces negative cardiovascular (CV) outcomes in patients with acute coronary syndromes. The need for a therapeutic range with the activated partial thromboplastin time (APTT) has not been validated in patients with arterial thrombosis who receive heparin. Therefore, it is unclear whether there is an association between recurrent CV events and low APTT values and between bleeding and high APTT values.

Methods and Results--We examined the relationship between the APTT and recurrent cardiovascular events and bleeding among 5058 patients with an acute coronary syndrome without ST elevation who received intravenous heparin in the OASIS-2 trial. The increase in relative risk of recurrent CV events was 1.54 (95% CI 1.10 to 2.15; P=0.01) among patients with APTT values <60 seconds compared with patients with APTT values 60 seconds. When patients had persistently subtherapeutic APTT values for more than 48 hours, the increase in relative risk of a recurrent CV event was 1.84 (95% CI 1.25 to 2.70). Higher APTT values were associated with bleeding; for every 10-second increase in the APTT, the probability of major bleeding was increased by 7% (95% CI 3% to 11%; P=0.0004).

Conclusions--In patients with acute coronary syndromes without ST elevation who are treated with intravenous heparin, our findings justify regular APTT monitoring to minimize recurrent ischemic events and bleeding.

Key words: heparin • thrombosis • coronary disease

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