Postprocedural Parenteral Anticoagulation in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes

Although the current guidelines discourage the use of anticoagulation after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), the recommendations are not well supported by evidence. We aimed to evaluate the association between postprocedural parenteral anticoagulant therapy and clinical outcomes in such patients.

We recruited NSTE-ACS patients registered in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome registry from November 1, 2014 to December 31, 2020. The patients were categorized according to whether postprocedural parenteral anticoagulant therapy was used after PCI. The primary outcomes were in hospital all-cause death and any bleeding.

Among included 14,427 eligible NSTE-ACS patients, 6,244 patients (43.3%) treated with postprocedural parenteral anticoagulant therapy were younger, with better cardiac function and lower bleeding risk score, less likely to have comorbidities, and had a longer median duration of hospital stay than those treated without postprocedural parenteral anticoagulant therapy. After inverse probability of treatment weighting adjustment for baseline differences, postprocedural parenteral anticoagulant therapy was not associated with a reduction of in hospital all-cause death (adjusted OR, 0.73; 95% CI, 0.43-1.22). However, the risk of in hospital any bleeding was higher in the postprocedural parenteral anticoagulant therapy group (adjusted OR, 1.31; 95% CI, 1.02-1.70). The subgroup analysis was consistent with the primary results.

Postprocedural parenteral anticoagulant therapy is not associated with a reduced risk of in hospital all-cause death but increased risk of any bleeding in patients with NSTE-ACS after PCI.