title: Safety of coronary angiography and percutaneous coronary intervention via the radial versus femoral route in patients on uninterrupted oral anticoagulation with warfarin.
abstract: OBJECTIVE
  To evaluate access site and other bleeding complications associated with radial versus femoral access in patients receiving oral anticoagulation (OAC) with warfarin.
  
  
  BACKGROUND
  Patients receiving OAC with warfarin undergoing coronary angiography and percutaneous coronary intervention (PCI) may have OAC continued despite the risk of bleeding. To what extent arterial access site impacts bleeding in such patients is not well studied.
  
  
  METHODS
  Over 6 years, we identified 255 consecutive patients in whom warfarin was continued who underwent coronary angiography with an international normalized ratio >1.8. A total of 97 patients also underwent PCI at the same setting (27% femoral vs 73% radial). The primary outcome was Bleeding Academic Research Consortium bleeds; a secondary end point was frequency of access site complications in the 72 hours post-PCI. Complications were evaluated based on the initial access site attempted.
  
  
  RESULTS
  Minimal baseline clinical characteristics differences existed between the groups. International normalized ratio was significantly higher in the radial group (2.42 ± 0.67 vs 2.24 ± 0.49, P = .02). Bivalirudin use was greater during radial PCI than femoral (76% vs 42%, P < .05), whereas unfractionated heparin alone was greater during femoral PCI than radial (46% vs 18%, P < .05). No significant difference was seen in the primary end point between femoral (2.8%) and radial (1.6%, P = .54) during coronary angiography alone. However, PCI via the femoral artery had significantly more Bleeding Academic Research Consortium bleeding (19.2% vs 1.4%, P = .005) and transfusions (15% vs 0%, P = .004) than via the radial artery. Patients who underwent PCI using radial access were less likely to have any vascular or bleeding complications (1% vs 23%, P = .001).
  
  
  CONCLUSIONS
  Patients who underwent coronary angiography during uninterrupted OAC had similar bleeding rates regardless of access site. However, when PCI was performed, radial access was associated with fewer bleeding and vascular complications than the femoral approach.
  
  
  CONCLUSIONS
  We retrospectively identified 255 consecutive patients on warfarin who underwent coronary angiography, 97 of whom underwent a percutaneous coronary intervention. The data reveal a reduction in Bleeding Academic Research Consortium bleeds (1.6% vs 8.1%, P = .02) with radial versus femoral access. The radial approach was associated with an overall lower rate of any vascular or bleeding complication than the femoral approach during percutaneous coronary intervention (1% vs 23%, P = .001).
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, PA.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: Department of General Internal Medicine, Geisinger Medical Center, Danville, PA.
authors.forename: Erik W
authors.initials: EW
authors.lastname: O'Connell
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, PA.
authors.forename: Wah Wah
authors.initials: WW
authors.lastname: Htun
authors.affiliation: Center for Health Research, Geisinger Medical Center, Danville, PA.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, PA.
authors.forename: Sandy M
authors.initials: SM
authors.lastname: Green
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, PA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Skelding
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, PA.
authors.forename: James C
authors.initials: JC
authors.lastname: Blankenship
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, PA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Scott
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, PA; Cardiovascular Center for Clinical Research, Geisinger Medical Center, Danville, PA. Electronic address: pbberger@geisinger.edu.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin