The activated clotting time first came into clinical use in the mid-1970s to guide the administration and reversal of heparin during cardiopulmonary bypass procedures. The explosive growth of cardiopulmonary bypass led to the development of automated techniques for measuring activated clotting times. Recent advances in the field of interventional cardiology have emphasized the importance of the coagulation cascade and the need for the prevention of thrombosis with anticoagulant drugs. The activated clotting time has emerged as an important means of monitoring and guiding heparin therapy during invasive intravascular procedures. This review focuses on the following topics: 1) the development of anticoagulation monitoring techniques; 2) current alternatives in bedside anticoagulation monitoring; and 3) the clinical application of activated clotting times outside surgery. Until prospective studies can establish appropriate "target" activated-clotting-time values for interventional procedures, procedural anticoagulation must be guided empirically. Nevertheless, the activated clotting time is extremely useful in the catheterization laboratory, for monitoring heparin therapy and the adequacy of anticoagulation.
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