title: Periprocedural management and in-hospital outcome of patients with indication for oral anticoagulation undergoing coronary artery stenting.
abstract: OBJECTIVE
  In patients on oral anticoagulation (OAC) undergoing coronary stenting (PCI-S), procedural management and in-hospital outcome have never been specifically and prospectively investigated. Also, the contribution of early bleeding to the relevant hemorrhagic rate reported at follow-up with triple therapy of OAC, aspirin, and clopidogrel is largely unknown.
  
  
  METHODS
  Consecutive patients with indication for OAC undergoing PCI-S at 5 centers were enrolled and prospectively evaluated.
  
  
  RESULTS
  Out of 3410 patients undergoing PCI-S in the study period, indication for OAC was present in 4.8%. Femoral approach and bare metal stents were the most frequently used. During PCI-S, OAC was continued in about 30% of patients, whereas in about 20% heparin bridging was carried out. Glycoprotein IIb/IIIa inhibitors were rarely used (11%), whereas a standard bolus of unfractionated heparin was given in 93% of cases. Major adverse cardiovascular events (MACE) occurred in 4.8% of patients and major bleeding in 4.3%. No predictors of MACE or bleeding were identified, although the femoral approach was of borderline significance for major bleeding (OR 4.6, 95% CI 1.0-20.8; P = 0.05). A history of previous hemorrhage (OR 5.3, 95% CI 1.6-18.1; P = 0.007) predicted Carbofilm-coated stent implantation.
  
  
  CONCLUSIONS
  A limited, albeit clinically relevant, proportion of patients undergoing PCI-S has indication for OAC. Procedural management appears not substantially different from that of common patients. In-hospital major bleeding is relevant and should be taken into account when evaluating the overall hemorrhagic rate at a medium- to long-term follow-up.
authors.affiliation: Cardiac Catheterization Laboratory, Division of Cardiology, Ospedale Maggiore, Bologna, Italy. andrearubboli@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.forename: Mauro
authors.initials: M
authors.lastname: Colletta
authors.forename: Josè
authors.initials: J
authors.lastname: Valencia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capecchi
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Franco
authors.forename: Luisa
authors.initials: L
authors.lastname: Zanolla
authors.forename: Luigi
authors.initials: L
authors.lastname: La Vecchia
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Piovaccari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use*; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000628:therapy; D003331:Coronary Vessels; D054855:Drug-Eluting Stents; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors