title: Meta-analysis of uninterrupted as compared to interrupted oral anticoagulation with or without bridging in patients undergoing coronary angiography with or without percutaneous coronary intervention.
abstract: OBJECTIVE
  To assess safety and effectiveness of different periprocedural antithrombotic strategies in patients receiving long-term oral anticoagulation and undergoing coronary angiography with or without percutaneous coronary intervention (PCI).
  
  
  METHODS
  Studies comparing uninterrupted oral anticoagulation (UAC) with vit. K antagonists vs interrupted oral anticoagulation (IAC) with or without bridging anticoagulation before coronary procedures were eligible for inclusion in the current meta-analysis. Endpoints selected were 30-day composite of major adverse cardiovascular or cerebrovascular and thromboembolic events (MACCE) and major bleeding.
  
  
  RESULTS
  Eight studies (7 observational and 1 randomized controlled trial [N=2325pts.]) were included in the analysis. There was no difference in MACCE between UAC and IAC; RR (95%CIs): 0.74 (0.34-1.64); p=0.46 but there was a statistically significant MACCE risk reduction with UAC as compared to IAC with bridging: 0.52 (0.29-0.95); p=0.03. Likewise, there were no statistically significant differences between UAC vs IAC in regard to major bleeding: 0.62 (0.16-2.43); p=0.49; but as compared to IAC with bridging, UAC was associated with statistically significant 65% lower risk of major bleeding: 0.35 (0.13-0.92); p=0.03. Additionally, meta-regression analysis revealed significant linear correlation between log RR of MACCE (β=-4.617; p<0.001) and major bleeding (β=6.665; p=0.022) and mean value of target INR suggestive of higher thrombotic and secondary haemorrhagic risk below estimated INR cut-off of 2.17-2.27 within 30days.
  
  
  CONCLUSIONS
  Uninterrupted OAC is at least as safe as interrupted OAC, and seems to be much safer than interrupted OAC with bridging anticoagulation in patients undergoing coronary angiography with or without PCI.
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Poland; Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz, Poland. Electronic address: kowalewskimariusz@gazeta.pl.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kowalewski
authors.affiliation: Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland; Pulaski University of Technology and Humanities, Radom, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Suwalski
authors.affiliation: Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Raffa
authors.affiliation: Department of Pathophysiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Słomka
authors.affiliation: Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Collegium Medicum in Bydgoszcz, Poland.
authors.forename: Magdalena Ewa
authors.initials: ME
authors.lastname: Kowalkowska
authors.affiliation: Department of Clinical Neuropsychology, Collegium Medicum, Bydgoszcz, Poland Nicolaus Copernicus University, Toruń, Poland.
authors.forename: Krzysztof Aleksander
authors.initials: KA
authors.lastname: Szwed
authors.affiliation: Department of Clinical Neuropsychology, Collegium Medicum, Bydgoszcz, Poland Nicolaus Copernicus University, Toruń, Poland.
authors.forename: Alina
authors.initials: A
authors.lastname: Borkowska
authors.affiliation: Lung Cancer and Thoracic Surgery Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kowalewski
authors.affiliation: University Hospital Southampton NHS Foundation Trust, Wessex Cardiothoracic Centre, Southampton, United Kingdom.
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Malvindi
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Center for Research and Medical Technology, John Paul II Hospital, Cracow, Poland.
authors.forename: Anetta
authors.initials: A
authors.lastname: Undas
authors.affiliation: Department of Disorders of Hemostasis and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Windyga
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Pawliszak
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Poland.
authors.forename: Lech
authors.initials: L
authors.lastname: Anisimowicz
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital and University of Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Paparella
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GYH
authors.lastname: Lip
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D017023:Coronary Angiography; D004334:Drug Administration Schedule; D006801:Humans; D062645:Percutaneous Coronary Intervention
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Bridging anticoagulation; Heparin; Meta-analysis; Oral anticoagulation; Percutaneous coronary intervention