Relation between systemic anticoagulation as determined by activated partial thromboplastin time and heparin measurements and in-hospital clinical events in unstable angina and non-Q wave myocardiaL infarction. Thrombolysis in Myocardial Ischemia III B Investigators

American Heart Journal
R C BeckerE Braunwald

Abstract

Although coronary thrombosis is thought to play a pivotal role in the pathogenesis of unstable angina and non-Q wave myocardial infarction and antithrombotic therapy is a mainstay in the early management of these patients, the relation between measures of systemic anticoagulation and clinical events has not been defined clearly. In the Thrombolysis in Myocardial Ischemia III trial, 1473 patients with ischemic chest pain at rest evaluated within 24 hours of symptom onset were randomized to (1) tissue plasminogen activator (TPA) or placebo and (2) an early invasive or an early conservative strategy. All patients received a full complement of anti-ischemic medication, aspirin, and continuous intravenous heparin titrated to an activated partial thromboplastin time (aPTT) of 1.5 to 2.0 times control for 72 to 96 hours. The median aPTT in all study groups exceeded the minimum threshold (45 seconds) by 24 hours and remained within the designated range during the protocol-directed heparin infusion. No differences in median aPTT values for the 72- to 96-hour study period were observed between groups (p=not significant). Median 12-hour heparin concentrations were >0.2 U/ml in all groups; however, values <0.2 U/ml were common thereafter, ...Continue Reading

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Citations

Oct 20, 1998·American Heart Journal·R A HarringtonS D Berkowitz
Jun 8, 2002·Current Cardiology Reports·Henock Saint-Jacques, And Robert A Harrington
Mar 4, 1998·Australian and New Zealand Journal of Medicine·M DuffyP Rosengarten
Dec 9, 2004·Pharmacotherapy·Omar BadawiStuart T Haines
Jul 30, 1999·American Heart Journal·J S HochmanB De La Fuente
Jun 21, 2017·Expert Review of Hematology·Israfil BaluwalaLeonardo Pasalic
Nov 27, 1999·Current Problems in Cardiology·C P Cannon

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