Outcomes
After the peri-procedural heparin protocol was initiated, the initial
weight-based bolus of heparin increased from 97±29 units/Kg to 113±29
units/Kg (p<0.001). ACT outcomes are shown in Figure 1.
Therapeutic values on first draw increased from 60% in the usual care
cohort, to 77% in the protocol guided cohort (Figure 1A, p=0.010). And
there was not a significant increase in supra-therapeutic values on
first ACT value after heparin administration (Figure 1B, 12% versus
20%, p=0.123). The total proportion of ACT values in therapeutic range
during the procedure increased from 79% to 86% with protocol guidance
(Figure 1C, OR 1.68, 95% CI 1.24 – 2.28, p=0.001). Supra-therapeutic
proportions also did not significantly increase between the usual care
and protocol guided cohorts (21% versus 25%, Figure 1D, OR 1.26, 95%
CI 0.89 – 1.78, p=0.198).
Time to therapeutic ACT decreased after initiation of the heparin
protocol (Figure 2). Time from heparin administration to therapeutic ACT
deceased from 37.3±18.8 minutes with usual care, to 31.1±16.4 minutes in
the protocol guided cohort (p=0.034). Similarly, time from transspetal
access to therapeutic ACT decreased from 30.2±22.3 min with usual care
to 19.8±17.3 in the protocol guided cohort (p=0.001).
There was only one major bleeding or thromboembolic event in either
cohort, which was a pseudoaneurysm formation with concomitant
ipsilateral common femoral vein thrombus identified in the protocol
guided cohort.