ACT Monitoring Anticoagulant Applications Of Patients With Coronary Heart Disease After Interventional Operation

Objective:It have shown that the activated clotting time (ACT) and activat ed partial thromboplastin time (APTT), can be used as bedside test at home and abroad and the correlation of both are good.ACT is a better method for monitoring the anticoagulant therapy.Patients with PCI add anticoagulant durin g and after operation is mostly called empiric treatment, the lack of individual monitoring for the coagulation status of patients, can cause the use of some p atients with anticoagulant excessive or insufficient and lead to adverse complic ations.How to solve the problem of anticoagulant make the heparin of patient s meet the standard, after operation the addition of anticoagulant can both ac ute bleeding and achieve good anticoagulant effect, stent implantation during operation and after operation ACT monitors activated clotting time (Activated ClottingTime, ACT),Can be observed at any time to take timely measures and can provide an objective basis for individual heparin dose and can provide sa fety guarantee for the stent implantation of operation at the same time. The pu rpose of this study is to investigate the acute myocardial infarction, ACT and APTT monitoring of ordinary heparin, and observe the unfractionated heparin i n patients undergoing PCI and postoperative metabolic situation, looking for th e the PCI of postoperative subcutaneous low molecular weight heparin reasona bletime.Method:observation of our hospital emergency department in accordance with AHA/ACC AMI diagnostic criteria without thrombolytic contraindications ST-seg ment elevation acute myocardial infarction in10cases, given r-tPA (domestic sm all dose method), r-tPA total dose of50mgIV bolus8mg,42mg intravenous drip t o finish the remaining90minutes. Before thrombolysis intravenous heparin70IU/Kg, the total does not exceed5000IU r-tPA drip Bi continuous intravenous infusi on of heparin1000IU/h for48hours, heparin dose adjustment according to A PTT time. ACT and APTT therapeutic range (45-70s) normal control (1.5-2.3fol d) observed correlation, to calculate the control value of the ACT within the ther apeutic range.Check the Department of Cardiology of our hospital, the diagnosis of80ca ses of patients with coronary heart disease (CHD), were treated with aspirin, clop idogrel, isosorbide dinitrate, lipid treatment patients were divided into group A (a ngiography) and group B (angiography and stent implantation), A, B treatment, b efore and after the detection of the ACT value. B group was divided into three s ubgroups, three subgroups of patients in the stent implantation3hours,6hours,8hours subcutaneous administration of low molecular weight heparin4100u, dete ction intravenous bolus of heparin before and after10minutes,2ACT values at different time points,4,6,8,12hours.Results:1thrombolytic therapy in patients with acute myocardial infarction, mon itoring unfractionated heparin anticoagulation, APTT therapeutic range as normal (1.5-2.0) when, ACT values and APTT values were positively correlated.(2) coronary artery after treatment compared with before treatment, ACT value is no significant difference (P>0.05), stent implantation group after treatment than before treatment prolonged ACT values (P<0.05), the difference was statistically significant; three sub-groups at each time point between the two groups (P>0.05),3subgroups ACT values at about10min after injection to a peak after4hours down to the preoperative level of basic,4-12hours compared with patients in eac h group slightly extended front group (P>0.05),4-12hour group among the gro ups, no significant differences (P>0.05).Conclusion:1.ACT and APTT two detection indicators showed a positive correla tion, and its detection is simple, convenient, and can be applied to the bedside m onitor heparin.2. the value of low molecular weight heparin has a certain influence on the ACT, aspirin, clopidogrel and other antiplatelet drugs no significant effect on the ACT values; postoperative subcutaneous low molecular weight heparin when no strict distinction, given4-6hours after clinical drugs can be.