Uninterrupted Oral Anticoagulant Therapy in Patients Undergoing Unplanned Percutaneous Coronary Intervention.
PCI
coronary angiography(s)
discontinuation
oral anticoagulant
uninterrupted
Journal
JACC. Cardiovascular interventions
ISSN: 1876-7605
Titre abrégé: JACC Cardiovasc Interv
Pays: United States
ID NLM: 101467004
Informations de publication
Date de publication:
12 04 2021
12 04 2021
Historique:
received:
10
09
2020
revised:
11
01
2021
accepted:
12
01
2021
entrez:
7
4
2021
pubmed:
8
4
2021
medline:
27
10
2021
Statut:
ppublish
Résumé
This study sought to compare interrupted and uninterrupted oral anticoagulant therapy (I-OAC vs. U-OAC) in patients on OAC undergoing percutaneous coronary intervention. There is a paucity of data regarding the optimal peri-procedural management of OAC-treated patients. In the SWEDEHEART registry, all patients on OAC who were admitted acutely and underwent percutaneous coronary intervention or coronary angiography with a diagnostic procedure, from 2005 to 2017, were included. Outcomes were major adverse cardiac and cerebrovascular events (MACCE; death, myocardial infarction, or stroke) and bleeds at 120 days. Propensity score was used to adjust for the nonrandomized treatment selection. The study included 6,485 patients: 3,322 in the I-OAC group and 3,163 in the U-OAC group. The cumulative incidence of MACCE was 8.2% (269 events) versus 8.2% (254 events) in the I-OAC and the U-OAC groups, respectively. The adjusted risk for MACCE did not differ between the groups (I-OAC vs. U-OAC hazard ratio: 0.89; 95% confidence interval: 0.71 to 1.12). Similarly, no difference was found in the risk for MACCE or bleeds (12.6% vs. 12.9%, adjusted hazard ratio: 0.87; 95% confidence interval: 0.70 to 1.07). The risk for major or minor in-hospital bleeds did not differ between the groups. However, U-OAC was associated with a significantly shorter duration of hospitalization: 4 (3 to 7) days versus 5 (3 to 8) days; p < 0.01. I-OAC and U-OAC were associated with equivalent risk for MACCE and bleeding complications. An U-OAC strategy was associated with shorter length of hospitalization. These data support U-OAC as the preferable strategy in patients on OAC undergoing coronary intervention.
Sections du résumé
OBJECTIVES
This study sought to compare interrupted and uninterrupted oral anticoagulant therapy (I-OAC vs. U-OAC) in patients on OAC undergoing percutaneous coronary intervention.
BACKGROUND
There is a paucity of data regarding the optimal peri-procedural management of OAC-treated patients.
METHODS
In the SWEDEHEART registry, all patients on OAC who were admitted acutely and underwent percutaneous coronary intervention or coronary angiography with a diagnostic procedure, from 2005 to 2017, were included. Outcomes were major adverse cardiac and cerebrovascular events (MACCE; death, myocardial infarction, or stroke) and bleeds at 120 days. Propensity score was used to adjust for the nonrandomized treatment selection.
RESULTS
The study included 6,485 patients: 3,322 in the I-OAC group and 3,163 in the U-OAC group. The cumulative incidence of MACCE was 8.2% (269 events) versus 8.2% (254 events) in the I-OAC and the U-OAC groups, respectively. The adjusted risk for MACCE did not differ between the groups (I-OAC vs. U-OAC hazard ratio: 0.89; 95% confidence interval: 0.71 to 1.12). Similarly, no difference was found in the risk for MACCE or bleeds (12.6% vs. 12.9%, adjusted hazard ratio: 0.87; 95% confidence interval: 0.70 to 1.07). The risk for major or minor in-hospital bleeds did not differ between the groups. However, U-OAC was associated with a significantly shorter duration of hospitalization: 4 (3 to 7) days versus 5 (3 to 8) days; p < 0.01.
CONCLUSIONS
I-OAC and U-OAC were associated with equivalent risk for MACCE and bleeding complications. An U-OAC strategy was associated with shorter length of hospitalization. These data support U-OAC as the preferable strategy in patients on OAC undergoing coronary intervention.
Identifiants
pubmed: 33826495
pii: S1936-8798(21)00125-4
doi: 10.1016/j.jcin.2021.01.022
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
754-763Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : ErratumIn
Informations de copyright
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures Dr. Venetsanos has received a grant from Boston Scientific. Dr. Janzon has received lecture fees from AstraZeneca and Pfizer. Dr. Böhm has received research grants and lecture fees from Abbott, Boston Scientific, AstraZeneca, and Bayer. Dr. Karlson has served on an advisory board for Biosense Webster. Dr. Simonsson has received lecture fees from AstraZeneca, Pfizer, and Bayer. Dr. Erlinge has received speaker fees from AstraZeneca and Bayer; and has served on advisory boards for Bayer and Boehringer Ingelheim. Dr. Omerovic has received an institutional research grant from AstraZeneca; and has received consulting fees from Novartis, Merck Sharp & Dohme, AstraZeneca, and Bayer. Dr. Alfredsson has received grants from AstraZeneca; has received lecture fees from AstraZeneca, Lilly, Pfizer, Bayer, Novartis, and Boehringer Ingelheim; and has served on advisory boards for AstraZeneca, Novartis, and Merck Sharp & Dohme. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.