Excess Dosing of Antithrombotic Therapy in Non–ST-Segment Elevation Acute Coronary Syndromes—Reply

Furthermore, despite strict adherence to dose titration nomograms in clinical trials, substantial fluctuations in aPTT are common within the first 24 hours of treatment.3 Therefore, both excess dosing and underdosing of unfractionated heparin are likely more prevalent in the "real world," where monitoring of aPTT may be less rigorous than in a study setting, and the true risk of serious bleeding complications due to an excess dose (as defined by aPTT above the therapeutic range) may be higher than reported. The CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/ American Heart Association Guidelines) registry may also provide valuable insights into bleeding risk assessment and its treatment implications. Practical implementation of the guidelines for unstable angina/non-ST-segment elevation myocardial infarction in the emergency department: a scientific statement from the American Heart Association Council on Clinical Cardiology (Subcommittee on Acute Cardiac Care), Council on Cardiovascular Nursing, and Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Society of Chest Pain Centers. The Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome (EARLY ACS) trial: a randomized placebo-controlled trial evaluating the clinical benefits of early front-loaded eptifibatide in the treatment of patients with non-ST-segment elevation acute coronary syndrome: study design and rationale.