Safety of percutaneous coronary intervention during uninterrupted oral anticoagulant treatment.
OBJECTIVE
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.


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 In the IAC group, warfarin was withdrawn for a mean of 3 days prior to PCI (mean INR 1.7).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.


CONCLUSIONS
Our study shows that PCI is a safe procedure during UAC with no excess bleeding complications.
Karjalainen
Pasi P
PP
Department of Cardiology, Satakunta Central Hospital, Pori, Finland.
Vikman
Saila
S
Niemelä
Matti
M
Porela
Pekka
P
Ylitalo
Antti
A
Vaittinen
Mari-Anne
MA
Puurunen
Marja
M
Airaksinen
Tuukka J
TJ
Nyman
Kai
K
Vahlberg
Tero
T
Airaksinen
K E Juhani
KE
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000925:Anticoagulants / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003327:Coronary Disease / Q000628:therapy*; D003328:Coronary Thrombosis / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic
D000925:Anticoagulants