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Published on: February 26, 2013
Use of Chronic Oral Anticoagulation and Associated Outcomes Among Patients Undergoing Percutaneous Coronary
Eric A Secemsky1, Neel M Butala2, Uri Kartoun3
1Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA Harvard Medical School, Boston, MA Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Insights
Patients on oral anticoagulants (OACs) undergoing percutaneous coronary intervention (PCI) face higher risks of bleeding and readmission. These OAC patients also experienced decreased long-term survival post-PCI, highlighting a need for improved safety measures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Contemporary use of oral anticoagulants (OACs) in patients undergoing percutaneous coronary intervention (PCI) and their outcomes are not well-documented.
- Understanding these trends is crucial for optimizing patient care and safety in interventional cardiology.
Purpose of the Study:
- To describe contemporary rates of OAC use among patients undergoing PCI.
- To evaluate the association between OAC therapy and in-hospital bleeding, mortality, and other adverse events following PCI.
Main Methods:
- Retrospective analysis of data from an integrated health care system (2009-2014).
- Identified patients on OACs within 30 days of PCI, comparing outcomes between OAC users and non-users.
- Used adjusted models to assess the association of OAC use with adverse events, including bleeding, readmission, and mortality.
Main Results:
- 8.8% of 9566 PCI patients were on OACs; non-vitamin K antagonist agent use increased significantly among these patients.
- OAC-treated patients had higher rates of major bleeding, access-site bleeding, and non-access-site bleeding post-PCI.
- Adjusted analyses revealed OAC use was linked to increased in-hospital bleeding (OR 1.50), 90-day readmissions (OR 1.40), and decreased long-term survival (HR 1.36).
Conclusions:
- Chronic OAC therapy is common in patients undergoing PCI.
- OAC use is associated with increased in-hospital bleeding, higher readmission rates, and reduced long-term survival after PCI.
- Further research and interventions are necessary to mitigate adverse events in this high-risk patient population.
Background:
Contemporary rates of oral anticoagulant (OAC) therapy and associated outcomes among patients undergoing percutaneous coronary intervention (PCI) have been poorly described.
Methods And Results:
Using data from an integrated health care system from 2009 to 2014, we identified patients on OACs within 30 days of PCI. Outcomes included in-hospital bleeding and mortality. Of 9566 PCIs, 837 patients (8.8%) were on OACs, and of these, 7.9% used non-vitamin K antagonist agents. OAC use remained stable during the study (8.1% in 2009, 9.0% in 2014; P=0.11), whereas use of non-vitamin K antagonist agents in those on OACs increased (0% in 2009, 16% in 2014; P<0.01). Following PCI, OAC-treated patients had higher crude rates of major bleeding (11% versus 6.5%; P<0.01), access-site bleeding (2.3% versus 1.3%; P=0.017), and non-access-site bleeding (8.2% versus 5.2%; P<0.01) but similar crude rates of in-hospital stent thrombosis (0.4% versus 0.3%; P=0.85), myocardial infarction (2.5% versus 3.0%; P=0.40), and stroke (0.48% versus 0.52%; P=0.88). In addition, prior to adjustment, OAC-treated patients had longer hospitalizations (3.9±5.5 versus 2.8±4.6 days; P<0.01), more transfusions (7.2% versus 4.2%; P<0.01), and higher 90-day readmission rates (22.1% versus 13.1%; P<0.01). In adjusted models, OAC use was associated with increased risks of in-hospital bleeding (odds ratio 1.50; P<0.01), 90-day readmission (odds ratio 1.40; P<0.01), and long-term mortality (hazard ratio 1.36; P<0.01).
Conclusions:
Chronic OAC therapy is frequent among contemporary patients undergoing PCI. After adjustment for potential confounders, OAC-treated patients experienced greater in-hospital bleeding, more readmissions, and decreased long-term survival following PCI. Efforts are needed to reduce the occurrence of adverse events in this population.
