What is the typical ACT target during a percutaneous coronary intervention (PCI) procedure?

• A. 50-100 seconds
• B. 400-450 seconds
• C. 250-300 seconds; higher if complex or CTO cases.
• D. 150-200 seconds

Answer: (C)

During PCI, anticoagulation with heparin is used to prevent clot formation as wires, balloons, and stents are manipulated in the coronary arteries. Activated clotting time (ACT) is measured to confirm we’re within a therapeutic window: high enough to protect against thrombus, but not so high that bleeding becomes a major risk.

The typical target ACT is about 250–300 seconds. This range provides effective anticoagulation for most PCI procedures. If the case is more complex or involves a chronic total occlusion (CTO), the thrombotic risk is greater and the procedure can be longer, so the ACT target is raised to reduce clot risk in those situations.

Values well below the target (like 50–100 seconds or 150–200 seconds) would leave the patient under-anticoagulated and prone to clot formation. Values well above the target (around 400–450 seconds) increase bleeding risk without added benefit in standard PCI.