Impact of Uninterrupted Versus Interrupted Oral Anticoagulation on 30-Day Outcomes Following Coronary Angiography

The rising prevalence of patients undergoing coronary angiography who require oral anticoagulation (OAC) presents a challenge in periprocedural management. While current North American guidelines advise OAC interruption before nonemergent coronary angiography, the impact of continuation vs interruption on outcomes remains unclear.

This retrospective study included patients who underwent elective outpatient transradial coronary angiography from August 1, 2018, to March 20, 2023 at a tertiary medical center. The primary end point included 30-day outcomes of hematoma, pseudoaneurysm, perforation, arteriovenous fistula, compartment syndrome, and stroke or transient ischemic attack.

Of the 470 patients, 225 patients (48%) continued OAC (uninterrupted group), and 245 patients (52%) had OAC stopped periprocedurally (interrupted group). There were no differences in baseline demographic characteristics and clinical characteristics. The uninterrupted group trended toward higher rates of warfarin use (17.3% vs 10.6%) and lower rates of rivaroxaban use (13.3% vs 20.4%; P = .031). The interrupted group had higher rates of conversion to the alternate radial access (6.1% vs 1.8%; P =.019) and percutaneous coronary intervention (46.5% vs 24.0%; P < .001). No significant differences were found between the interrupted and uninterrupted groups with respect to 30-day rates of hematoma (2.9% vs 4.0%; P = .495), pseudoaneurysm (0.8% vs 0%; P = .5), and stroke or transient ischemic attack (1.2% vs 0.4%; P = .625), respectively. No perforations, arteriovenous fistula, or compartment syndrome were observed at 30 days.

In this institutional registry of patients who underwent elective outpatient transradial coronary angiography, an uninterrupted OAC strategy was not associated with higher rates of 30-day complications.