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Peer-reviewedCC BY-NC 4.0Clinical and Applied Thrombosis/Hemostasis

Clinical Significance of Time in Therapeutic Range (TTR) During Unfractionated Heparin Therapy in Non-ST-Segment Elevation Myocardial Infarction

  • Tal Golani1,2
  • Louay Taha1,2
  • Mohammad Karmi1,2
  • Abed Qadan1,2
  • Akiva Brin1,2
  • Noam Fink3,4
  • Pierre Sabouret5,6
  • Mamas A. Mamas7
  • Amjad Abu-Salman1,2
  • Eyal Ben-Zvi1,2
  • Ari Naimark2,8
  • Motaz Amro1,2
4 more authors
  • Mony Shuvy1,2
  • Asher Schnur1,2
  • Michael Glikson1,2
  • Elad Asher1,2
8 affiliations
  1. 1Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem, Israel
  2. 2Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
  3. 3Hospital Management, Assuta Medical Centers, Tel Aviv, Israel
  4. 4Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  5. 5Action Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
  6. 6National College of French Cardiologists, Paris, France
  7. 7Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
  8. 8Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
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Abstract

Background: Unfractionated heparin (UFH) is widely used in non-ST-segment elevation myocardial infarction (NSTEMI), but its narrow therapeutic window requires frequent activated partial thromboplastin time (aPTT) monitoring. Data on time in therapeutic range (TTR) in this setting are scarce.

Methods: We analyzed 1,553 consecutive patients with NSTEMI treated with UFH in a tertiary care intensive cardiovascular care unit between July 2019 and December 2025. TTR was calculated by linear interpolation over 72 hours. Associations with complications and 30-day and 1-year mortality were assessed.

Results: Among them (mean age 67.1 ± 13.8 years, 73.9% male), only 325 (20.9%) reached the therapeutic range. Mean TTR was 12.5 ± 20.2%. An early invasive strategy predominated: 85.5% underwent coronary angiography, approximately 89% of them within 24 hours (mean time to angiography 14.4 ± 10.1 hours). Therapeutic-range attainment was not associated with mortality at 30 days (4.6% vs 4.0%, p=0.614) or 1 year (8.6% vs 9.3%, p=0.710), even after multivariable adjustment (adjusted OR 1.30, 95% CI 0.70–2.40 and 0.98, 95% CI 0.62–1.55, respectively). It was also not associated with in-hospital complications, including re-infarction, stroke, stent thrombosis, or bleeding.

Conclusions: Therapeutic aPTT was achieved infrequently, and neither therapeutic-range attainment nor TTR was associated with clinical outcomes. These findings suggest that, using a contemporary approach to NSTEMI with a short time to angiography in the great majority of cases, TTR does not represent an optimal marker of anticoagulation quality, warranting evaluation of alternative strategies. Given the low event rate, confirmation in larger, adequately powered studies is required.

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Cite

BibTeXRIS
BibTeX
@article{golani2026clinical,
  title = {{Clinical Significance of Time in Therapeutic Range (TTR) During Unfractionated Heparin Therapy in Non-ST-Segment Elevation Myocardial Infarction}},
  author = {Tal Golani and Louay Taha and Mohammad Karmi and Abed Qadan and Akiva Brin and Noam Fink and Pierre Sabouret and Mamas A. Mamas and Amjad Abu-Salman and Eyal Ben-Zvi and Ari Naimark and Motaz Amro and Mony Shuvy and Asher Schnur and Michael Glikson and Elad Asher},
  journal = {Clinical and Applied Thrombosis/Hemostasis},
  year = {2026},
  month = sep,
  doi = {10.1177/10760296261493181},
  url = {https://doi.org/10.1177/10760296261493181},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Clinical Significance of Time in Therapeutic Range (TTR) During Unfractionated Heparin Therapy in Non-ST-Segment Elevation Myocardial Infarction
AU  - Tal Golani
AU  - Louay Taha
AU  - Mohammad Karmi
AU  - Abed Qadan
AU  - Akiva Brin
AU  - Noam Fink
AU  - Pierre Sabouret
AU  - Mamas A. Mamas
AU  - Amjad Abu-Salman
AU  - Eyal Ben-Zvi
AU  - Ari Naimark
AU  - Motaz Amro
AU  - Mony Shuvy
AU  - Asher Schnur
AU  - Michael Glikson
AU  - Elad Asher
PY  - 2026
DA  - 2026/09/28
JO  - Clinical and Applied Thrombosis/Hemostasis
DO  - 10.1177/10760296261493181
UR  - https://doi.org/10.1177/10760296261493181
AB  - Background: Unfractionated heparin (UFH) is widely used in non-ST-segment elevation myocardial infarction (NSTEMI), but its narrow therapeutic window requires frequent activated partial thromboplastin time (aPTT) monitoring. Data on time in therapeutic range (TTR) in this setting are scarce.  Methods: We analyzed 1,553 consecutive patients with NSTEMI treated with UFH in a tertiary care intensive cardiovascular care unit between July 2019 and December 2025. TTR was calculated by linear interpolation over 72 hours. Associations with complications and 30-day and 1-year mortality were assessed.  Results: Among them (mean age 67.1 ± 13.8 years, 73.9% male), only 325 (20.9%) reached the therapeutic range. Mean TTR was 12.5 ± 20.2%. An early invasive strategy predominated: 85.5% underwent coronary angiography, approximately 89% of them within 24 hours (mean time to angiography 14.4 ± 10.1 hours). Therapeutic-range attainment was not associated with mortality at 30 days (4.6% vs 4.0%, p=0.614) or 1 year (8.6% vs 9.3%, p=0.710), even after multivariable adjustment (adjusted OR 1.30, 95% CI 0.70–2.40 and 0.98, 95% CI 0.62–1.55, respectively). It was also not associated with in-hospital complications, including re-infarction, stroke, stent thrombosis, or bleeding.  Conclusions: Therapeutic aPTT was achieved infrequently, and neither therapeutic-range attainment nor TTR was associated with clinical outcomes. These findings suggest that, using a contemporary approach to NSTEMI with a short time to angiography in the great majority of cases, TTR does not represent an optimal marker of anticoagulation quality, warranting evaluation of alternative strategies. Given the low event rate, confirmation in larger, adequately powered studies is required.
SN  - 1076-0296
SN  - 1938-2723
ER  -