European Heart Journal Advance Access originally published online on March 16, 2008
European Heart Journal 2008 29(8):1001-1010; doi:10.1093/eurheartj/ehn099
Safety of percutaneous coronary intervention during uninterrupted oral anticoagulant treatment
1 Department of Cardiology, Satakunta Central Hospital, Pori, Finland
2 Heart Center, University Hospital of Tampere, Tampere, Finland
3 Department of Internal Medicine, Division of Cardiology, University of Oulu, Oulu, Finland
4 Department of Medicine, Turku University Hospital, Turku, Finland
5 Department of Cardiology, Vaasa Central Hospital, Vaasa, Finland
6 Department of Cardiology, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland
7 University of Oulu, Oulu, Finland
8 Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
9 Department of Biostatistics, University of Turku, Turku, Finland
Received 31 May 2007; revised 1 February 2008; accepted 14 February 2008; online publish-ahead-of-print 16 March 2008.
* Corresponding author. Tel: +358 2 3131005, Fax: +358 2 3132030. Email: juhani.airaksinen{at}tyks.fi
Aims: Uninterrupted anticoagulation (UAC) is assumed to increase bleeding and access-site complications. A common consensus is to postpone percutaneous coronary interventions (PCI) to reach international normalized ratio (INR) levels < 1.5–1.8.
Methods and results: To assess the safety and feasibility of UAC, we analysed retrospectively all consecutive patients (n = 523) on warfarin therapy referred for PCI in four centres with a policy to interrupt anticoagulation (IAC) before PCI and in three centres with a long experience on UAC during PCI. Major bleeding, access-site complications, and major adverse cardiac events (death, myocardial infarction, target vessel revascularization, and stent thrombosis) were recorded during hospitalization. In the IAC group, warfarin was withdrawn for a mean of 3 days prior to PCI (mean INR 1.7). In the UAC group, mean INR value was 2.2. Glycoprotein IIb/IIIa (GP) inhibitors (P < 0.001) and low-molecular-weight heparins (P < 0.001) were more often used in the IAC group. Major bleeding and access-site complications were more common in the IAC group (5.0% vs. 1.2%, P = 0.02 and 11.3% vs. 5.0%, P = 0.01, respectively) than in the UAC group. After adjusting for propensity score, the group difference in access-site complications remained significant [OR (odds ratio) 2.8, 95% CI (confidence interval) 1.3–6.1, P = 0.008], but did not remain significant in major bleeding (OR 3.9, 95% CI 1.0–15.3, P = 0.05). In multivariable analysis, femoral access (OR 9.9, 95% CI 1.3–75.2), use of access-site closure devices (OR 2.1, 95% CI 1.1–4.0), low-molecular-weight heparin (OR 2.7, 95% CI 1.1–6.7) and old age predicted access-site complications, and the use of GP inhibitors (OR 3.0, 95% CI 1.0–9.1) remained as a predictor of major bleeding.
Conclusion: Our study shows that PCI is a safe procedure during UAC with no excess bleeding complications.
Key Words: Angioplasty • Warfarin • Anticoagulation • Complications • Bleeding
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