Percutaneous Coronary Intervention Without Interruption of Oral Anticoagulation

HomeCirculation: Cardiovascular InterventionsVol. 14, No. 2Percutaneous Coronary Intervention Without Interruption of Oral Anticoagulation Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBPercutaneous Juan G. Córdoba-Soriano, MD, Francisco Oteo, Antonio Gutiérrez-Díez, Andrés Escudero-Díaz, Arsenio Gallardo-López, José Portero-Portaz, Pablo Salinas, PhD, Elena Pérez-Pereira, Driss Melehi, PhD and Jesús Jiménez-Mazuecos, MD Córdoba-SorianoJuan Córdoba-Soriano Correspondence to: Córdoba Soriano, Cardiology Department, Complejo Hospitalario Universitario de Albacete, C/Hermanos Falcó 37 02006, Spain. Email E-mail Address: [email protected] https://orcid.org/0000-0003-4645-6268 Interventional Unit, Spain (J.G.C.-S., A.G.-D., A.G.-L., J.J.P.-P., D.M., J.J.-M.). Search for more papers by this author , OteoJuan Oteo https://orcid.org/0000-0002-2641-4135 Hospital Puerta Hierro, Majadahonda, Madrid, (J.F.O.). Gutiérrez-DíezAntonio Gutiérrez-Díez Escudero-DíazAndrés Escudero-Díaz Institute, Clínico San Carlos, (A.E.-D., P.S.). Gallardo-LópezArsenio Gallardo-López Portero-PortazJuan Portero-Portaz https://orcid.org/0000-0002-0479-4659 SalinasPablo Salinas https://orcid.org/0000-0003-4040-4029 Pérez-PereiraElena Pérez-Pereira https://orcid.org/0000-0001-5318-8818 HM Torrelodones, (E.P.-P.). MelehiDriss Melehi Jiménez-MazuecosJesús Jiménez-Mazuecos Originally published5 Feb 2021https://doi.org/10.1161/CIRCINTERVENTIONS.120.009949Circulation: Interventions. 2021;14:e009949Other version(s) articleYou are viewing the most recent version article. Previous versions: February 5, 2021: Ahead Print Up 10% patients undergoing percutaneous coronary intervention (PCI) receive oral anticoagulation (OAC) up 30% with atrial fibrillation require PCI.1 The management situation in stable is highly variable but centers, OAC withdrawn within 72 hours before restarted 48 after PCI, bridging heparin a significant percentage cases. Despite several trials having assessed antithrombotic regimen post-PCI anticoagulated patients, others that have demonstrated increase bleeding caused bridging, there lack evidence about safety performing PCI without interruption while avoiding especially on direct (DOAC).Our objective was address question prospective multicenter observational registry scheduled or ad hoc, uninterrupted chronic syndrome acute syndrome, conducted between July 2017 June 2020. Exclusion criteria included withholding last dose DOAC an international normalized ratio <1.8 case vitamin-K antagonists (VKAs) elective procedures at increased risk perforation riskier anatomies such as total occlusions, calcified lesions, rotational atherectomy, left main, grafts, remaining vessel. Administration unfractionated (UFH) (50–70 IU/kg) encouraged ST-segment elevation myocardial infarction any 1.8 2.5 taking VKA regardless clinical presentation. ischemic hemorrhagic events during procedure 24 (Table). Statistical analysis used SPSS 17.0 (SPSS, Inc; Chicago, IL). institutional ethics committee approved study, which Spanish Drug Agency classified postauthorization it received endorsement Association Cardiology. All gave informed consent. Data supporting study available from corresponding upon reasonable request.Table. Baseline, Procedural Characteristics, Safety OutcomesTotalDOACVKAP value*n=149n=90n=59Baseline Age, y74±973±875±100.36 Male112 (75.2)70 (77.8)42 (71.2)0.43 BMI, kg/m228±528±528±50.47 HAS-BLED2.7±12.6±12.7±10.72 CHA2DS2-VASC4.2±1.54.4±1.53.9±1.30.11 INR (median, range)2.2 (1.8–4.5)1.4 (1–2.7)2.4 (1.8–4.5)0.02 Hypertension126 (84.6)78 (86.7)48 (81.4)0.38 Diabetes60 (40.3)44 (48.9)16 (27.1)0.08 Dyslipidemia95 (63.8)61 (67.8)34 (57.6)0.21 Smoking56 (37.6)37 (41.1)19 (32.2)0.27 Prior PCI51 (34.2)28 (31.1)23 (39)0.32 CABG7 (4.7)5 (5.6)2 (3.4)0.54 Peripheral arteriopathy22 (14.8)14 (15.6)8 (13.6)0.73 stroke14 (9.4)10 (11.1)4 (6.8)0.37 Type Dabigatran28 (18.8)28 (18.8)0 (0)… Apixaban35 (23.5)35 (23.5)0 Edoxaban10 (6.7)10 (6.7)0 Rivaroxaban17 (11.4)17 (11.4)0 Acenocumarol59 (39.6)0 (0)59 (100)…Indication Atrial fibrillation127 (85.2)85 (94.4)42 (71.2)0.03 Mechanical prostheses9 (6)0 (0)9 (15.3)0.01 Deep venous thrombosis5 (3.4)2 (2.2)3 (5.1)0.13 Pulmonary embolism5 (3.4)3 (3.3)2 (3.4)0.78 Thrombophilia2 (1.3)0 (0)2 (3.4)0.18 Intracavitary thrombus1 (0.7)0 (0)1 (1.7)0.21Indication Scheduled65 (43.7)47 (52.2)18 (30.5)0.01 Ad hoc84 (56.3)43 (47.7)41 (69.5)0.03 Ambulatory78 (52.3)56 (62.2)22 (37.3)0.01 NSTEMI42 (28.2)21 (23.3)21 (35.6)0.21 STEMI26 (17.4)13 (14.4)13 (22)0.16Procedure Introducer size 5 French3 (2)3 (3.3)0 (0)0.11 6 French142 (95.3)84 (93.3)58 (98.3)0.56 7 French4 (2.7)3 (3.3)1 (1.7)0.18 Vascular access Radial139 (93.3)84 (93.3)55 (93.2)0.81 Ulnar3 (2)2 (2.2)1 (1.7)0.73 Femoral7 (4.7)4 (4.4)3 (5.1)0.69 Crossover5 (5.1)0.41 Band compression142 (95.3)86 (95.5)56 (94.9)0.85 Compression time, min199±58200±60198±550.78 Closure device7 (5.1)0.71 Vessel treated LAD102 (68.4)59 (65.5)43 (72.8)0.37 Cx31 (20.8)16 (17.7)15 (25.4)0.26 RCA49 (32.8)34 (37.7)15 (25.4)0.32 DES138 (92.6)84 (93.3)54 (91.5)0.81 BMS11 (7.4)6 (6.7)5 (8.5)0.75 Stent length, mm26±1427±1524±130.87 diameter, mm3±0.63±0.63±0.60.92Periprocedural treatment UFH (IU)5240±25505202±25725296±25320.67 Aspirin117 (78.5)62 (70)54 (91.5)0.03 Clopidogrel125 (83.9)68 (75.5)53 (89.8)0.04 Ticagrelor1 (2)0.82 Prasugrel1 (0.7)1 (1.1)0 (0)0.79 Abciximab1 (0)0.87 Dual therapy32 (21.5)15 (16.7)17 (28.8)0.21 Triple therapy117 (78.5)75 (83.3)42 (71.2)0.42Periprocedural outcomes Nonsevere9 (6)6 (6.6)3 (5.1)0.67 Access perforation0 (0)0 Edge dissection2 (3.4)0.15 Perforation0 No reflow2 (1.3)2 (2.2)0 (0)0.36 Side branch occlusion5 (3.4)4 (4.4)1 (1.7)0.34 Severe2 (1.4)2 (0)0.56 thrombosis1 (0)0.61 Acute vessel closure0 Tamponade0 Catheter Stroke0 Systemic embolism0 (0)…Post-procedure—24 h access3 (2)1 (1.1)2 (3.4)0.72 Bleeding compression†2 (1.3)1 (1.1)1 (1.7)0.63 Hematoma‡1 (1.7)0.39 Pseudoaneurysm0 Fistula0 Radial occlusion§0 embolism1 (1.7)0.60 thrombosis0 Periprocedural infarction∥7 (3.4)0.43 Bleeding¶1 (1.7)0.37 Death0 (0)…Values n (%) mean±SD. BARC indicates Academic Research Consortium; body mass index; BMS, bare metal stent; CABG, artery bypass grafting; Cx, circumflex artery; DES, drug-eluting DOAC, anticoagulation; EASY, Early Discharge After Transradial Stenting Arteries Study; HAS-BLED, hypertension, abnormal renal liver function, stroke, bleeding, labile INR, elderly, drugs alcohol; ratio; LAD, anterior descending; NSTEMI, non-ST-segment infarction; OAC, intervention; RCA, right STEMI, UFH, heparin; VKA, vitamin K antagonist.* P value comparison vs VKA.† compression: need new bandage due incomplete hemostasia.‡ hematoma ≥II according EASY.§ Pulse palpation leaving catheterization surveillance room.∥ Fourth definition infarction.¶ BARC≥2.Most 149 were receiving underwent syndrome. Approximately half ambulatory performed hoc. profile single-vessel angioplasty (90.6%), through radial access, only one stent. Most (95.3%) mainly 50 IU/kg, combined 2 antiplatelets. AngioSeal (Terumo, Japan) all femoral cases, whereas cases average 3.5 compression sufficient achieve hemostasis. Two (1.4%) presented serious intraprocedural complications. A possible catheter thrombosis occurred nontarget embolization patient apixaban-clopidogrel who also UFH. second intrastent nonocclusive aspirin-clopidogrel-rivaroxaban abciximab. tamponade, embolisms, strokes occurred. We registered embolism (toe) BARC-2 (Bleeding Consortium 2) first post-procedure.This followed current expert recommendations,1,2 whose pillars following: do not withdraw perform bridge therapy, go radial, use additional parenteral except ≥2.5. Furthermore, we recommended addition based results dabigatran rivaroxaban showed level provided could be insufficient.3,4 main findings low rate complications periprocedural thrombotic aforementioned insufficient probably reason why occurred: patient, using stent case. At hours, observed embolic complication, related peripheral arteriopathy no major bleeding. These highlight advantages strategy where approach generally used. On other hand, removing restarting may trigger transient prothrombotic effect because C S proteins. Indeed, even short durations shown thromboembolic events. Larger-scale previous studies reported similar interruption,5 our best knowledge, largest DOAC. Finally, confusion frequent among physicians, strategies might simplify. limitations consider those inherent nature selection biases sample size. However, can conclude intermediate doses seems safe facilitates considerable PCI. future randomized question.Sources FundingNone.Disclosures None.FootnotesFor Sources Funding Disclosures, see page 236.Correspondence jgcorso.[email protected]comReferences1. Ruiz-Nodar JM, Ferreiro JL. Antithrombotic therapy revascularization treatment.REC Interv Cardiol. 2019; 1:41–50. doi: 10.24875/RECICE.M19000010Google Scholar2. 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D (2021) Uninterrupted Percutaneous Intervention, JACC: Interventions, 10.1016/j.jcin.2021.04.027, 14:12, (1381-1382), 1-Jun-2021. 2021Vol Issue 2Article InformationMetrics © 2021 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.120.009949PMID: 33541101 publishedFebruary Keywordsatrial fibrillationregistriesanticoagulantspercutaneous interventionPDF download Advertisement SubjectsAnticoagulantsCatheter-Based Valvular InterventionsPercutaneous InterventionPharmacology