Abstract：
BACKGROUND: Unfractionated heparin (UFH) is the preferred anticoagulant agent in percutaneous coronary intervention (PCI) procedures for minimising the risk of thrombotic complications. Because of the narrow therapeutic range of UFH, some society guidelines have advocated the use of the activated clotting time (ACT) test to monitor anticoagulation intensity during PCI to reduce thrombotic and bleeding complications. We aimed to assess the current practice of UFH prescription and its monitoring in Australia and New Zealand (ANZ).
METHODS: We conducted an anonymous voluntary cross-sectional survey of interventional cardiologists (ICs) who were members of the Cardiac Society of Australia and New Zealand in 2022. The survey included 10 questions pertaining to the current practice of anticoagulation during PCI.
RESULTS: Of 430 ICs surveyed, 148 responded (response rate, 34.4%). Most ICs (84.4%) prescribed 70-100 IU/kg of UFH for PCI. Over half of ICs (58.7%) routinely measured ACT during PCI, whereas only 22.2% routinely measured ACT after PCI to guide additional UFH prescription. Among ICs who prescribed additional UFH, approximately half (48%) aimed for ACT ≥250 seconds. Factors that influenced post-PCI UFH prescription included vascular access site and concomitant antiplatelet or anticoagulant therapy.
CONCLUSIONS: The contemporary practice of UFH prescription during PCI and ACT monitoring in ANZ is variable and based on outdated evidence preceding current drug-eluting stents, antiplatelet therapies, and radial-first practice. Current society guideline recommendations lack clarity and agreement, reflecting the quality of the available evidence. Up-to-date clinical trials evaluating UFH prescription and ACT monitoring are needed to optimise clinical outcomes in contemporary PCI procedures.
METHODS: We conducted an anonymous voluntary cross-sectional survey of interventional cardiologists (ICs) who were members of the Cardiac Society of Australia and New Zealand in 2022. The survey included 10 questions pertaining to the current practice of anticoagulation during PCI.
RESULTS: Of 430 ICs surveyed, 148 responded (response rate, 34.4%). Most ICs (84.4%) prescribed 70-100 IU/kg of UFH for PCI. Over half of ICs (58.7%) routinely measured ACT during PCI, whereas only 22.2% routinely measured ACT after PCI to guide additional UFH prescription. Among ICs who prescribed additional UFH, approximately half (48%) aimed for ACT ≥250 seconds. Factors that influenced post-PCI UFH prescription included vascular access site and concomitant antiplatelet or anticoagulant therapy.
CONCLUSIONS: The contemporary practice of UFH prescription during PCI and ACT monitoring in ANZ is variable and based on outdated evidence preceding current drug-eluting stents, antiplatelet therapies, and radial-first practice. Current society guideline recommendations lack clarity and agreement, reflecting the quality of the available evidence. Up-to-date clinical trials evaluating UFH prescription and ACT monitoring are needed to optimise clinical outcomes in contemporary PCI procedures.
摘要：
背景：普通肝素（UFH）是经皮冠状动脉介入治疗（PCI）手术中的首选抗凝剂，可最大程度降低血栓并发症的风险。由于UFH的治疗范围狭窄，一些社会指南提倡使用活化凝血时间(ACT)试验来监测PCI期间的抗凝强度,以减少血栓形成和出血并发症.我们旨在评估澳大利亚和新西兰（ANZ）的UFH处方及其监控的当前做法。
方法：我们于2022年对澳大利亚和新西兰心脏学会成员的介入心脏病学家（IC）进行了一项匿名自愿横断面调查。该调查包括与PCI期间抗凝治疗的当前实践有关的10个问题。
结果：在接受调查的430个IC中，148回应(回应率，34.4%）。大多数IC（84.4％）为PCI规定了70-100IU/kg的UFH。超过一半的IC（58.7％）在PCI期间常规测量ACT，而只有22.2％在PCI后常规测量ACT以指导其他UFH处方。在规定了额外UFH的IC中，大约一半(48%)的目标是ACT≥250秒。影响PCI后UFH处方的因素包括血管通路部位和伴随的抗血小板或抗凝治疗。
结论：ANZPCI和ACT监测期间UFH处方的当代实践是可变的，并且基于当前药物洗脱支架之前的过时证据，抗血小板治疗,径向第一练习。当前的社会准则建议缺乏明确性和一致性，反映现有证据的质量。需要评估UFH处方和ACT监测的最新临床试验，以优化当代PCI程序的临床结果。
方法：我们于2022年对澳大利亚和新西兰心脏学会成员的介入心脏病学家（IC）进行了一项匿名自愿横断面调查。该调查包括与PCI期间抗凝治疗的当前实践有关的10个问题。
结果：在接受调查的430个IC中，148回应(回应率，34.4%）。大多数IC（84.4％）为PCI规定了70-100IU/kg的UFH。超过一半的IC（58.7％）在PCI期间常规测量ACT，而只有22.2％在PCI后常规测量ACT以指导其他UFH处方。在规定了额外UFH的IC中，大约一半(48%)的目标是ACT≥250秒。影响PCI后UFH处方的因素包括血管通路部位和伴随的抗血小板或抗凝治疗。
结论：ANZPCI和ACT监测期间UFH处方的当代实践是可变的，并且基于当前药物洗脱支架之前的过时证据，抗血小板治疗,径向第一练习。当前的社会准则建议缺乏明确性和一致性，反映现有证据的质量。需要评估UFH处方和ACT监测的最新临床试验，以优化当代PCI程序的临床结果。
