Comparison of Additional Versus No Additional Heparin During Therapeutic Oral Anticoagulation in Patients Undergoing Percutaneous Coronary Intervention

Autor: Matti Niemelä, Pasi P. Karjalainen, Tuomas Kiviniemi, Fausto Biancari, Saila Vikman, Mikko Pietilä, Kari Eino Juhani Airaksinen, Marja Puurunen, Antti Ylitalo
Rok vydání: 2012
Předmět:
Male
medicine.medical_specialty
Ticlopidine
Time Factors
Injections
Subcutaneous
medicine.medical_treatment
Administration
Oral
Coronary Artery Disease
030204 cardiovascular system & hematology
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Fibrinolytic Agents
Internal medicine
Atrial Fibrillation
Preoperative Care
medicine
Humans
Prospective Studies
030212 general & internal medicine
Angioplasty
Balloon
Coronary
Adverse effect
Aged
Aspirin
Heparin
business.industry
Anticoagulants
Percutaneous coronary intervention
Thrombosis
Atrial fibrillation
Odds ratio
medicine.disease
Confidence interval
Clopidogrel
3. Good health
Treatment Outcome
Conventional PCI
Propensity score matching
Cardiology
Drug Therapy
Combination
Female
Warfarin
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Follow-Up Studies
medicine.drug
Zdroj: The American Journal of Cardiology. 110:30-35
ISSN: 0002-9149
Popis: Uninterrupted oral anticoagulation (OAC) therapy can be the preferred strategy in patients with atrial fibrillation at moderate to high risk of thromboembolism undergoing percutaneous coronary intervention (PCI). To evaluate the need for additional heparins in addition to therapeutic peri-PCI OAC, we assessed bleeding complications and major adverse cardiac and cerebrovascular events in 414 consecutive patients undergoing PCI during therapeutic (international normalized ratio 2 to 3.5) periprocedural OAC. Patients were divided into those with no (n = 196) and with (n = 218) additional use of periprocedural heparins. No differences in major adverse cardiac and cerebrovascular events (4.1% vs 3.2%, p = 0.79) or major bleeding (1.0% vs 3.7%, p = 0.11) were detected, but access site complications (5.1% vs 11.0%, p = 0.032) were less frequent in those without additional heparins. When adjusted for propensity score, patients with additional heparins had a higher risk of access site complications (odds ratio 2.6, 95% confidence interval 1.1 to 6.1, p = 0.022) without any increased risk of any other adverse event. Analysis of 1-to-1 propensity-matched pairs showed a significantly higher risk of access site complication in patients receiving additional AC (13.1% vs 5.7%, p = 0.049). In conclusion, therapeutic warfarin treatment seems to provide sufficient AC for PCI. Additional heparins are not needed and may increase access site complications.
Databáze: OpenAIRE
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