Safety of percutaneous coronary intervention during uninterr

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Research published early online in the European Heart Journal suggests that percutaneous coronary intervention (PCI) is safe even if performed during uninterrupted anticoagulation (UAC).

According to the researchers, a common consensus is to postpone PCI until international normalised ratio (INR) levels of < 1.5–1.8 are reached. Therefore, the safety and efficacy of various periprocedural antithrombotic strategies in patients on long-term oral anticoagulation with warfarin was investigated.
The study involved a retrospective analysis of 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 UAC during PCI.
Major bleeding, access-site complications, and major adverse cardiac events (death, myocardial infarction, target vessel revascularisation, and stent thrombosis) were recorded during hospitalisation. A total of 241 patients underwent PCI without pauses in warfarin therapy (the UAC group; mean INR = 2.2), and in 254 patients (IAC group), oral anticoagulation treatment with warfarin was stopped before the procedure (mean 3.0 days, range 1–30 days). Furthermore, a total of 28 patients underwent PCI when warfarin treatment was interrupted on the day of the index procedure.

The following results were reported:
• 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).
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