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Uninterrupted Oral Anticoagulant Therapy in Patients Undergoing Unplanned Percutaneous Coronary Intervention

Venetsanos, Dimitrios ; Skibniewski, Mikolaj ; Janzon, Magnus ; Lawesson, Sofia S. ; Charitakis, Emmanouil ; Böhm, Felix ; Henareh, Loghman ; Andell, Pontus LU ; Karlson, Lars O. and Simonsson, Moa , et al. (2021) In JACC: Cardiovascular Interventions 14(7). p.754-763
Abstract

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... (More)

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.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
coronary angiography(s), discontinuation, oral anticoagulant, PCI, uninterrupted
in
JACC: Cardiovascular Interventions
volume
14
issue
7
pages
10 pages
publisher
Elsevier
external identifiers
  • pmid:33826495
  • scopus:85103267062
ISSN
1936-8798
DOI
10.1016/j.jcin.2021.01.022
language
English
LU publication?
no
id
d170e493-4f4c-4164-a17f-6ca3c58a0fee
date added to LUP
2021-04-07 07:36:20
date last changed
2024-06-29 10:27:55
@article{d170e493-4f4c-4164-a17f-6ca3c58a0fee,
  abstract     = {{<p>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 &lt; 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.</p>}},
  author       = {{Venetsanos, Dimitrios and Skibniewski, Mikolaj and Janzon, Magnus and Lawesson, Sofia S. and Charitakis, Emmanouil and Böhm, Felix and Henareh, Loghman and Andell, Pontus and Karlson, Lars O. and Simonsson, Moa and Völz, Sebastian and Erlinge, David and Omerovic, Elmir and Alfredsson, Joakim}},
  issn         = {{1936-8798}},
  keywords     = {{coronary angiography(s); discontinuation; oral anticoagulant; PCI; uninterrupted}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{754--763}},
  publisher    = {{Elsevier}},
  series       = {{JACC: Cardiovascular Interventions}},
  title        = {{Uninterrupted Oral Anticoagulant Therapy in Patients Undergoing Unplanned Percutaneous Coronary Intervention}},
  url          = {{http://dx.doi.org/10.1016/j.jcin.2021.01.022}},
  doi          = {{10.1016/j.jcin.2021.01.022}},
  volume       = {{14}},
  year         = {{2021}},
}