Periprocedural management and in-hospital outcome of patients with indication for oral anticoagulation undergoing coronary artery stenting
| Autor: | Giancarlo Piovaccari, Giuseppe Di Pasquale, Luisa Zanolla, Josè Valencia, Luigi La Vecchia, Andrea Rubboli, Mauro Colletta, Nicoletta Franco, Alessandro Capecchi |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Coronary Artery Disease Risk Factors Angioplasty Confidence Intervals Odds Ratio Medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Prospective Studies Angioplasty Balloon Coronary Prospective cohort study Aspirin Intraoperative Care business.industry Anticoagulants Drug-Eluting Stents Odds ratio Clopidogrel Coronary Vessels Surgery Clinical trial Hospitalization Logistic Models Treatment Outcome Conventional PCI Cardiology and Cardiovascular Medicine business Mace Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Journal of interventional cardiology. 22(4) |
| ISSN: | 1540-8183 |
| Popis: | Purpose In patients on oral anticoagulation (OAC) undergoing coronary stenting (PCI-S), procedural management and in-hospital outcome have never been specifically and prospectively investigated. Also, the contribution of early bleeding to the relevant hemorrhagic rate reported at follow-up with triple therapy of OAC, aspirin, and clopidogrel is largely unknown. Methods Consecutive patients with indication for OAC undergoing PCI-S at 5 centers were enrolled and prospectively evaluated. Results Out of 3410 patients undergoing PCI-S in the study period, indication for OAC was present in 4.8%. Femoral approach and bare metal stents were the most frequently used. During PCI-S, OAC was continued in about 30% of patients, whereas in about 20% heparin bridging was carried out. Glycoprotein IIb/IIIa inhibitors were rarely used (11%), whereas a standard bolus of unfractionated heparin was given in 93% of cases. Major adverse cardiovascular events (MACE) occurred in 4.8% of patients and major bleeding in 4.3%. No predictors of MACE or bleeding were identified, although the femoral approach was of borderline significance for major bleeding (OR 4.6, 95% CI 1.0-20.8; P = 0.05). A history of previous hemorrhage (OR 5.3, 95% CI 1.6-18.1; P = 0.007) predicted Carbofilm-coated stent implantation. Conclusions A limited, albeit clinically relevant, proportion of patients undergoing PCI-S has indication for OAC. Procedural management appears not substantially different from that of common patients. In-hospital major bleeding is relevant and should be taken into account when evaluating the overall hemorrhagic rate at a medium- to long-term follow-up. |
| Databáze: | OpenAIRE |
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