title: Comparison of additional versus no additional heparin during therapeutic oral anticoagulation in patients undergoing percutaneous coronary intervention.
abstract: Uninterrupted oral anticoagulation (OAC) therapy can be the preferred strategy in patients with atrial fibrillation at moderate to high risk of thromboembolism undergoing percutaneous coronary intervention (PCI). To evaluate the need for additional heparins in addition to therapeutic peri-PCI OAC, we assessed bleeding complications and major adverse cardiac and cerebrovascular events in 414 consecutive patients undergoing PCI during therapeutic (international normalized ratio 2 to 3.5) periprocedural OAC. Patients were divided into those with no (n = 196) and with (n = 218) additional use of periprocedural heparins. No differences in major adverse cardiac and cerebrovascular events (4.1% vs 3.2%, p = 0.79) or major bleeding (1.0% vs 3.7%, p = 0.11) were detected, but access site complications (5.1% vs 11.0%, p = 0.032) were less frequent in those without additional heparins. When adjusted for propensity score, patients with additional heparins had a higher risk of access site complications (odds ratio 2.6, 95% confidence interval 1.1 to 6.1, p = 0.022) without any increased risk of any other adverse event. Analysis of 1-to-1 propensity-matched pairs showed a significantly higher risk of access site complication in patients receiving additional AC (13.1% vs 5.7%, p = 0.049). In conclusion, therapeutic warfarin treatment seems to provide sufficient AC for PCI. Additional heparins are not needed and may increase access site complications.
authors.affiliation: Department of Medicine, Turku University Hospital, Turku, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kiviniemi
authors.forename: Pasi
authors.initials: P
authors.lastname: Karjalainen
authors.forename: Mikko
authors.initials: M
authors.lastname: Pietilä
authors.forename: Antti
authors.initials: A
authors.lastname: Ylitalo
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.forename: Saila
authors.initials: S
authors.lastname: Vikman
authors.forename: Marja
authors.initials: M
authors.lastname: Puurunen
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Kari Eino Juhani
authors.initials: KE
authors.lastname: Airaksinen
mesh_terms: D000284:Administration, Oral; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin