Periprocedural management and in-hospital outcome of patients with indication for oral anticoagulation undergoing coronary artery stenting.
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.
Rubboli
Andrea
A
Cardiac Catheterization Laboratory, Division of Cardiology, Ospedale Maggiore, Bologna, Italy. andrearubboli@libero.it
Colletta
Mauro
M
Valencia
Josè
J
Capecchi
Alessandro
A
Franco
Nicoletta
N
Zanolla
Luisa
L
La Vecchia
Luigi
L
Piovaccari
Giancarlo
G
Di Pasquale
Giuseppe
G
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
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors