Abstract 14903: Impact of Triple Antithrombotic Therapy on Amount of Unfractionated Heparin During Percutaneous Coronary Intervention
Introduction: Monitoring of activated clotting time (ACT) is most frequently used to assess the degree of anticoagulation with unfractionated heparin (UFH) during percutaneous coronary intervention (PCI). Patients receiving oral anticoagulation including warfarin and direct oral anticoagulant (DOAC) who underwent PCI usually require dual antiplatelet therapy (DAPT). Such triple antithrombotic therapy (TATT) may be correlated with elevated bleeding risk, but it is unclear whether we should reduce UFH using ACT monitoring for the patients with TATT during PCI or not.
Purpose: We investigated the effect of oral anticoagulants on ACT.
Methods: We enrolled consecutive patients with DAPT who underwent elective PCI in our hospital from January 2014 to December 2015. We excluded the dialysis patients. We divided our patients into three groups: the patients with only DAPT, with DAPT + warfarin, and with DAPT + DOAC. We compared ACT values which were measured at 30 minutes after initial UFH, whose amount was determined by body weight, administration during the procedure among three groups.
Results: The results among three groups were shown in a table. ACT and age was significantly different among three groups, but the other parameters including gender, body surface area (BSA), body mass index (BMI), serum-creatinine, amount of UFH per a kilogram were similar among three groups. In comparison between each two groups in terms of ACT, ACT was higher in DAPT + Warfarin group (n=26), and DAPT + DOAC group (n=16) than only DAPT group (n=295) (Only DAPT vs. DAPT + Warfarin; p<0.001, Only DAPT vs. DAPT + DOAC: p=0.013) and similar between DAPT + warfarin group and DAPT + DOAC group (p=0.836).
Conclusions: ACT values during PCI were prolonged in the patients with TATT as compared to those with DAPT while initial dose of UFH was similar. The degree of effect on ACT is similar between warfarin and DOAC. We should reduce the amount of UFH during PCI in patients with triple antithrombotic therapy.
- Direct factor Xa inhibitor
- Direct thrombin inhibitor
- Percutaneous coronary intervention (PCI)
Author Disclosures: N. Okamoto: None. R. Shutta: None. M. Yasunaga: None. K. Yanagawa: None. Y. Matsuhiro: None. H. Nakamura: None. K. Yasumoto: None. K. Yasumura: None. A. Tanaka: None. N. Mori: None. D. Nakamura: None. M. Yano: None. N. Makino: None. Y. Egami: None. M. Nishino: None. J. Tanouchi: None.
- © 2016 by American Heart Association, Inc.