Use of bedside activated partial thromboplastin time monitor to adjust heparin dosing after thrombolysis for acute myocardial infarction: Results of GUSTO-I

K. M. Zabel, C. B. Granger, R. C. Becker, E. G. Bovill, J. Hirsh, P. E. Aylward, E. J. Topol, R. M. Califf

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21 Citations (Scopus)


Background: The safety and efficacy of bedside monitors of activated partial thromboplastin time (aPTT) have not been examined in a large population receiving intravenous heparin after thrombolytic treatment for acute myocardial infarction. We compared outcomes among patients monitored with these devices versus standard monitoring methods. Methods and Results: Investigators chose the bedside device (n = 1713 patients) or their standard method (n = 26,162) for all aPTT measurements at their sites. Clinical outcomes at 30 days, 1-year mortality rate, and aPTT levels at 6, 12, and 24 hours were compared. Bedside-monitored patients had significantly less moderate/severe bleeding (10% vs 12%, P < .01), fewer transfusions (7% vs 11%, P < .001), and a smaller decrease in hematocrit (5.5% vs 6.7%, P < .001) but significantly more recurrent ischemia (22% vs 20%, P = .01). Fewer bedside-monitored patients had subtherapeutic aPTT levels at 12 and 24 hours. Among patients with subtherapeutic levels at 6 and 12 hours, more bedside- monitored patients had therapeutic levels when next monitored. After adjustment for baseline differences, no significant difference in mortality rate was observed in bedside-monitored patients at 30 days (4.3% vs 4.8%, P = .27) and at 1 year (7.1% vs 7.7%, P = .38). The groups had similar rates of reinfarction, shock, heart failure, and stroke. Conclusion: This prospective substudy supports the use of bedside monitoring of heparin anticoagulation after thrombolysis.

Original languageEnglish
Pages (from-to)868-876
Number of pages9
JournalAmerican Heart Journal
Issue number5
Publication statusPublished or Issued - 1998

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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