title: Use of Chronic Oral Anticoagulation and Associated Outcomes Among Patients Undergoing Percutaneous Coronary Intervention.
abstract: Contemporary rates of oral anticoagulant (OAC) therapy and associated outcomes among patients undergoing percutaneous coronary intervention (PCI) have been poorly described.
  
  
  
  Using data from an integrated health care system from 2009 to 2014, we identified patients on OACs within 30 days of PCI. Outcomes included in-hospital bleeding and mortality. Of 9566 PCIs, 837 patients (8.8%) were on OACs, and of these, 7.9% used non-vitamin K antagonist agents. OAC use remained stable during the study (8.1% in 2009, 9.0% in 2014; P=0.11), whereas use of non-vitamin K antagonist agents in those on OACs increased (0% in 2009, 16% in 2014; P<0.01). Following PCI, OAC-treated patients had higher crude rates of major bleeding (11% versus 6.5%; P<0.01), access-site bleeding (2.3% versus 1.3%; P=0.017), and non-access-site bleeding (8.2% versus 5.2%; P<0.01) but similar crude rates of in-hospital stent thrombosis (0.4% versus 0.3%; P=0.85), myocardial infarction (2.5% versus 3.0%; P=0.40), and stroke (0.48% versus 0.52%; P=0.88). In addition, prior to adjustment, OAC-treated patients had longer hospitalizations (3.9±5.5 versus 2.8±4.6 days; P<0.01), more transfusions (7.2% versus 4.2%; P<0.01), and higher 90-day readmission rates (22.1% versus 13.1%; P<0.01). In adjusted models, OAC use was associated with increased risks of in-hospital bleeding (odds ratio 1.50; P<0.01), 90-day readmission (odds ratio 1.40; P<0.01), and long-term mortality (hazard ratio 1.36; P<0.01).
  
  
  
  Chronic OAC therapy is frequent among contemporary patients undergoing PCI. After adjustment for potential confounders, OAC-treated patients experienced greater in-hospital bleeding, more readmissions, and decreased long-term survival following PCI. Efforts are needed to reduce the occurrence of adverse events in this population.
authors: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors: Eric A
authors: EA
authors: Secemsky
authors: Harvard Medical School, Boston, MA Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors: Neel M
authors: NM
authors: Butala
authors: Center for Systems Biology and Center for Assessment Technology & Continuous Health (CATCH), Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA.
authors: Uri
authors: U
authors: Kartoun
authors: Department of Quality, Safety and Value, Partners HealthCare, Boston, MA.
authors: Sadiqa
authors: S
authors: Mahmood
authors: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA.
authors: Jason H
authors: JH
authors: Wasfy
authors: Saint Luke's Mid-America Heart Institute, Kansas City, MO.
authors: Kevin F
authors: KF
authors: Kennedy
authors: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA Center for Systems Biology and Center for Assessment Technology & Continuous Health (CATCH), Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA.
authors: Stanley Y
authors: SY
authors: Shaw
authors: Harvard Medical School, Boston, MA Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA ryeh@bidmc.harvard.edu.
authors: Robert W
authors: RW
authors: Yeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology / Q000601:surgery*; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D000069604:Dabigatran / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery*; D016017:Odds Ratio; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D012307:Risk Factors; D000069552:Rivaroxaban / Q000627:therapeutic use; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: anticoagulant; bleeding; mortality; percutaneous coronary intervention; readmission