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 |
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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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