Relationship between activated clotting time during percutaneous intervention and subsequent bleeding complications

Effect of Switching Antithrombin Agents for Primary Angioplasty in Acute Myocardial Infarction

“…Even with an initial ACT Ͼ200 s (present in 36.2% of patients), switching to bivalirudin was not associated with increased rates of major bleeding or blood transfusion compared with those Ischemic Complications in the 2 Groups Table 4 Ischemic Complications in the 2 Groups Dangas et al June 7, :2309 Switching Antithrombotics for Primary PCI in STEMI who switched with a shorter initial ACT, despite a markedly higher peak ACT level. The lack of a relationship between the ACT level with bivalirudin and hemorrhagic complications is consistent with previous reports with this agent in STEMI (12). The observations from this study may streamline and optimize care of the patient with STEMI undergoing primary PCI.…”

Factors related to a clinically silent peri-procedural drop in hemoglobin with coronary and peripheral vascular interventions

“…17 These reports include patients with both clinically evident and clinically silent (subclinical) peri-procedural bleeding events. 1,7,8,11,12,[18][19][20][21] Recent studies have shown that clinically silent peri-procedural blood loss is strongly associated with increased mortality and contrast-induced nephropathy. 22,23 The predictors of a clinically silent or subclinical periprocedural drop in hemoglobin have not been defined.…”

“…1,2 In addition to an increased mortality risk, other potential deleterious consequences of bleeding, including a hypercoagulable state, interruption of anti-platelet therapy, exacerbation of coronary ischemia and the harmful effect of a blood transfusion. [3][4][5][6] Predictors of PCI-related peri-procedural bleeding include increasing age, 7 female sex, 8 lower body weight, 9 chronic renal impairment, 10 history of hypertension, 11 baseline anemia, 7 glycoprotein 2b3a inhibitor, 7 low molecular weight heparin, 7 activated clotting time > 250 seconds, [12][13][14] femoral as compared to radial access, 15 intra-aortic balloon pump, 7 larger sheath diameter, 16 delayed sheath removal, 15,17 and procedure time greater than 60 minutes. 17 These reports include patients with both clinically evident and clinically silent (subclinical) peri-procedural bleeding events.…”

Endovascular treatment of a massive retroperitoneal bleeding: Successful balloon-catheter delivery of intra-arterial thrombin

“…Although the majority of patients who develop this complication can successfully be managed conservatively with blood replacement, this form of bleeding can occasionally be fatal [3,4]. Several studies have found that old age (> 80 years), female gender, peripheral vascular disease, postprocedural anticoagulation, low nadir platelet count, use of fibrinolytic agents [4,6], and, more recently, the peak of activated clotting time during PCI, as well as the use of a IIb/IIIa platelet receptor inhibitors, are all independent predictors for postprocedural development of retroperitoneal bleeding [7,8]. Consequently, in order to minimize the fatality rate in patients with this risk profile, a close surveillance after the procedure is mandatory, and intervention should be carried out without delay when they develop manifestations of blood loss.…”