During a coronary intervention, if the activated clotting time (ACT) is not within the therapeutic range despite administering weight-based unfractionated heparin, what alternative options do you consider?  

I would consider additional bonuses of 2000–5000 units of heparin and recheck ACT. If the ACT continues to be below the therapeutic range, consider alternate anticoagulation such as bivalrudin, 2b3a inhibition, and low molecular weight heparin. I also assume we have checked the ACT device. In ...