Comparison of additional versus no additional heparin during therapeutic oral anticoagulation in patients undergoing...

Area of Science:

• Cardiology
• Interventional Cardiology
• Thrombosis Management

Background:

• Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) require anticoagulation.
• Uninterrupted oral anticoagulation (OAC) is a strategy for these patients.
• The necessity of additional heparin during PCI alongside OAC is debated.

Purpose of the Study:

• To assess the impact of additional periprocedural heparins on bleeding and major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing PCI with therapeutic OAC.
• To determine if additional heparin provides benefits beyond therapeutic OAC during PCI.

Main Methods:

• Retrospective analysis of 414 patients undergoing PCI with therapeutic OAC (INR 2-3.5).
• Patients were stratified into two groups: those without (n=196) and with (n=218) additional periprocedural heparins.
• Propensity score analysis and 1-to-1 propensity-matched pair analysis were used to adjust for confounding factors.

Main Results:

• No significant differences in MACCE (4.1% vs 3.2%, p=0.79) or major bleeding (1.0% vs 3.7%, p=0.11) between groups.
• Patients without additional heparins had fewer access site complications (5.1% vs 11.0%, p=0.032).
• Propensity score adjustment and matched-pair analysis confirmed a higher risk of access site complications with additional heparins (OR 2.6, p=0.022; 13.1% vs 5.7%, p=0.049).

Conclusions:

• Therapeutic warfarin provides adequate anticoagulation for PCI in AF patients.
• Additional periprocedural heparins are not necessary and may increase the risk of access site complications.
• Current OAC strategies appear sufficient, potentially simplifying peri-PCI management.