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Pasi P. Karjalainen, Saila Vikman, Matti Niemelä, Pekka Porela, Antti Ylitalo, Mari-Anne Vaittinen, Marja Puurunen, Tuukka J. Airaksinen, Kai Nyman, Tero Vahlberg, K.E. Juhani Airaksinen, Safety of percutaneous coronary intervention during uninterrupted oral anticoagulant treatment, European Heart Journal, Volume 29, Issue 8, April 2008, Pages 1001–1010, https://doi.org/10.1093/eurheartj/ehn099
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Abstract
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.
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 In the IAC group, warfarin was withdrawn for a mean of 3 days prior to PCI (mean INR 1.7).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.
Our study shows that PCI is a safe procedure during UAC with no excess bleeding complications.
