European Heart Journal Advance Access originally published online on March 30, 2005
European Heart Journal 2005 26(15):1506-1512; doi:10.1093/eurheartj/ehi181
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Prognostic implication of activated partial thromboplastin time after reteplase or half-dose reteplase plus abciximab: results from the GUSTO-V trial
1University of Michigan Medical Center, B1-238 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI, USA
2New York University School of Medicine, New York, NY, USA
3Duke Clinical Research Institute, Durham, NC, USA
4The Chaim Sheba Medical Center, Tel-Hashomer, Israel
5University Hospital Nottingham, Nottingham, UK
6Green Lane Hospital, Auckland, New Zealand
7University of Alberta, Edmonton, Canada
8Niguarda Hospital, Milan, Italy
9Cleveland Clinic Foundation, Cleveland, OH, USA
Received 24 June 2004; revised 20 January 2005; accepted 27 January 2005; online publish-ahead-of-print 30 March 2005.
* Corresponding author. Tel: +1 734 936 5840; fax: +1 734 936 7026. E-mail address: ebates{at}umich.edu
This paper was guest edited by Prof. Bernard J. Gersh, Mayo Clinic, Rochester, MN, USA
Aims To evaluate the relationship between activated partial thromboplastin time (aPTT) and clinical outcomes in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-V) trial comparing standard-dose reteplase to half-dose reteplase and abciximab.
Methods and results We analysed data on 11 420 patients receiving unfractionated heparin. Peak aPTT levels recorded during the hospitalization were correlated with clinical outcomes. Multivariable logistic regression models examined the relationship between peak aPTT levels and (i) moderate-to-severe bleeding, (ii) intracerebral haemorrhage, (iii) reinfarction, and (iv) 30-day mortality. Non-linear relationships were explored in the models using cubic spline functions. Higher rates of significant complications were seen in both groups when aPTT levels were <50 s or when levels were >70 s. In the combination therapy group, the relationship between aPTT levels and bleeding appeared accentuated. Reinfarction rates increased gradually as aPTT levels were >70 s in both groups, but the relationships were not statistically significant. Peak aPTT levels <50 s were associated with increased 30-day mortality even after multivariable adjustment.
Conclusion Peak aPTT levels <50 s and >70 s are associated with worse clinical outcomes in the modern era of fibrinolytic therapy; these relationships are different in patients receiving standard reteplase vs. combination therapy.
Key Words: Fibrinolysis • Glycoprotein IIb/IIIa receptor blockade • Acute myocardial infarction • Heparin