| Safety of percutaneous coronary intervention during uninterrupted oral anticoagulant treatment. | |
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MedLine Citation:
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PMID: 18346963 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: Uninterrupted anticoagulation (UAC) is assumed to increase bleeding and access-site complications. A common consensus is to postpone percutaneous coronary interventions (PCI) to reach international normalized ratio (INR) levels < 1.5-1.8. METHODS AND RESULTS: To assess the safety and feasibility of UAC, we analysed retrospectively all consecutive patients (n = 523) on warfarin therapy referred for PCI in four centres with a policy to interrupt anticoagulation (IAC) before PCI and in three centres with a long experience on UAC during PCI. Major bleeding, access-site complications, and major adverse cardiac events (death, myocardial infarction, target vessel revascularization, and stent thrombosis) were recorded during hospitalization. In the IAC group, warfarin was withdrawn for a mean of 3 days prior to PCI (mean INR 1.7). In the UAC group, mean INR value was 2.2. Glycoprotein IIb/IIIa (GP) inhibitors (P < 0.001) and low-molecular-weight heparins (P < 0.001) were more often used in the IAC group. Major bleeding and access-site complications were more common in the IAC group (5.0% vs. 1.2%, P = 0.02 and 11.3% vs. 5.0%, P = 0.01, respectively) than in the UAC group. After adjusting for propensity score, the group difference in access-site complications remained significant [OR (odds ratio) 2.8, 95% CI (confidence interval) 1.3-6.1, P = 0.008], but did not remain significant in major bleeding (OR 3.9, 95% CI 1.0-15.3, P = 0.05). In multivariable analysis, femoral access (OR 9.9, 95% CI 1.3-75.2), use of access-site closure devices (OR 2.1, 95% CI 1.1-4.0), low-molecular-weight heparin (OR 2.7, 95% CI 1.1-6.7) and old age predicted access-site complications, and the use of GP inhibitors (OR 3.0, 95% CI 1.0-9.1) remained as a predictor of major bleeding. CONCLUSION: Our study shows that PCI is a safe procedure during UAC with no excess bleeding complications. |
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Authors:
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Pasi P Karjalainen; Saila Vikman; Matti Niemelä; Pekka Porela; Antti Ylitalo; Mari-Anne Vaittinen; Marja Puurunen; Tuukka J Airaksinen; Kai Nyman; Tero Vahlberg; K E Juhani Airaksinen |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2008-03-16 |
Journal Detail:
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Title: European heart journal Volume: 29 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 2008 Apr |
Date Detail:
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Created Date: 2008-04-15 Completed Date: 2008-08-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 1001-10 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Satakunta Central Hospital, Pori, Finland. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary / adverse effects* Anticoagulants / therapeutic use* Blood Loss, Surgical / prevention & control* Coronary Disease / therapy* Coronary Thrombosis / prevention & control* Epidemiologic Methods Female Humans Male Practice Guidelines as Topic |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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