From the Research
There is no specific target value for APTT that must be achieved before a PCI procedure, but rather a focus on managing antiplatelet therapy and ensuring coagulation tests are within normal ranges. Generally, APTT should be within normal ranges before PCI, with typical ranges being 25-35 seconds, though reference ranges may vary between laboratories 1. The management of antiplatelet therapy is more crucial before PCI, with patients typically receiving a loading dose of aspirin and a P2Y12 inhibitor such as clopidogrel, ticagrelor, or prasugrel before the procedure. For patients on oral anticoagulants, these medications are often held before PCI, with warfarin typically discontinued 3-5 days prior to achieve an INR <1.8, while direct oral anticoagulants (DOACs) are usually held for 24-48 hours depending on renal function.
Some studies have investigated the optimal level of anticoagulation during PCI, with one study suggesting that an activated clotting time (ACT) in the range of 350 to 375 seconds provides the lowest composite ischemic event rate 2. However, this does not directly translate to a specific APTT target. Another study found that low APTT values were not associated with an increase in ischemic events, whereas high APTT values were associated with more frequent bleeding complications 1.
The focus on antiplatelet therapy rather than specific APTT targets reflects the pathophysiology of coronary interventions, where platelet activation and aggregation play a more significant role in acute complications than the coagulation cascade measured by APTT. Key considerations before PCI include:
- Managing antiplatelet therapy with aspirin and a P2Y12 inhibitor
- Holding oral anticoagulants before PCI, with specific guidelines for warfarin and DOACs
- Ensuring coagulation tests, including APTT, are within normal ranges
- Monitoring patients for signs of ischemia or bleeding complications during and after the procedure.