Periprocedural management and in-hospital outcome of patients with indication for oral anticoagulation undergoing coronary artery stenting
Andrea Rubboli, Mauro Colletta, Josè Valencia, Alessandro Capecchi, Nicoletta Franco, Luisa Zanolla, Luigi La Vecchia, Giancarlo Piovaccari, Giuseppe Di Pasquale, WARfarin and Coronary STENTing (WAR-STENT) Study Group, Andrea Rubboli, Mauro Colletta, Josè Valencia, Alessandro Capecchi, Nicoletta Franco, Luisa Zanolla, Luigi La Vecchia, Giancarlo Piovaccari, Giuseppe Di Pasquale, WARfarin and Coronary STENTing (WAR-STENT) Study Group
Abstract
Purpose: In patients on oral anticoagulation (OAC) undergoing coronary stenting (PCI-S), procedural management and in-hospital outcome have never been specifically and prospectively investigated. Also, the contribution of early bleeding to the relevant hemorrhagic rate reported at follow-up with triple therapy of OAC, aspirin, and clopidogrel is largely unknown.
Methods: Consecutive patients with indication for OAC undergoing PCI-S at 5 centers were enrolled and prospectively evaluated.
Results: Out of 3410 patients undergoing PCI-S in the study period, indication for OAC was present in 4.8%. Femoral approach and bare metal stents were the most frequently used. During PCI-S, OAC was continued in about 30% of patients, whereas in about 20% heparin bridging was carried out. Glycoprotein IIb/IIIa inhibitors were rarely used (11%), whereas a standard bolus of unfractionated heparin was given in 93% of cases. Major adverse cardiovascular events (MACE) occurred in 4.8% of patients and major bleeding in 4.3%. No predictors of MACE or bleeding were identified, although the femoral approach was of borderline significance for major bleeding (OR 4.6, 95% CI 1.0-20.8; P = 0.05). A history of previous hemorrhage (OR 5.3, 95% CI 1.6-18.1; P = 0.007) predicted Carbofilm-coated stent implantation.
Conclusions: A limited, albeit clinically relevant, proportion of patients undergoing PCI-S has indication for OAC. Procedural management appears not substantially different from that of common patients. In-hospital major bleeding is relevant and should be taken into account when evaluating the overall hemorrhagic rate at a medium- to long-term follow-up.
Source: PubMed