Peri-Procedural Management of Oral Anticoagulant Therapy in Patients Undergoing Percutaneous Coronary Intervention:...

The optimal management of patients on oral anticoagulant therapy (OAT) undergoing percutaneous coronary intervention (PCI) remains debated. There are three possible strategies: performing the procedure on OAT, bridging OAT with heparins or stopping OAT.

In this sub-analysis of the PERSEO multicenter registry, we selected a cohort of patients on OAT undergoing PCI and we appraised in-hospital outcomes according to three different peri-procedural strategies: uninterrupted OAT, interrupted OAT, and interrupted OAT with bridging therapy.

The study population consisted of 763 patients, of whom 76% were receiving direct oral anticoagulants (DOACs) whereas the remaining were on vitamin K antagonists (VKAs). OAT was interrupted in 70%, bridged in 24% and continued in 6% of patients, the latter mainly undergoing emergent procedures. The overall rates of major adverse cardiac and cerebrovascular events and bleedings were 1.7% and 6.8%, respectively. The overall rate of thromboembolic events was very low (0.1%), even in patients who interrupted OAT (0.2%). Bridging strategy (OR 2.39, 95% CI 1.12-5.09), increasing age (OR 1.07, 95% CI 1.02-1.12) and white blood cell count (OR 1.17, 95% CI 1.07-1.27) were independently associated with bleedings, whereas radial approach was a protective factor (OR 0.36, 95% CI 0.17-0.77). Continued anticoagulation (bridging therapy or OAT) was also an independent predictor of bleedings (OR 2.22, 95% CI 1.21-4.08).

In this study, OAT interruption was a safe strategy for both bleedings and thromboembolic events, whereas continued anticoagulation, especially bridging, was associated with increased bleeding rate. Radial approach should be preferred in this clinical setting.

The PERSEO study was registered on ClinicalTrials.gov with the ID NCT03392948 (last update 2022-07-22).