PCI safe during continuing anticoagulant therapy

NEW YORK (Reuters Health) - Percutaneous coronary intervention (PCI) can be conducted safely during uninterrupted oral anticoagulant treatment, according to Finnish researchers.

"The management of the increasing patient group anticoagulated with warfarin and referred for PCI," senior investigator Dr. K. E. Juhani Airaksinen told Reuters Health, "represents a substantial challenge to the physician who must balance the risks of periprocedural hemorrhage, thrombotic complications and...

NEW YORK (Reuters Health) - Percutaneous coronary intervention (PCI) can be conducted safely during uninterrupted oral anticoagulant treatment, according to Finnish researchers.

"The management of the increasing patient group anticoagulated with warfarin and referred for PCI," senior investigator Dr. K. E. Juhani Airaksinen told Reuters Health, "represents a substantial challenge to the physician who must balance the risks of periprocedural hemorrhage, thrombotic complications and thromboembolism."

As reported in the April issue of the European Heart Journal, Dr. Airaksinen of the University of Turku and colleagues retrospectively studied data on 241 patients who underwent PCI without a pause in anticoagulation, 254 in whom anticoagulation was stopped for a mean of 3 days before the procedure, and 28 whose warfarin was stopped on the day of the procedure.

Major bleeding was more common in the interrupted group (5%) than in the uninterrupted group (1.2%). This was also the case for access site complications (11.3% versus 5.0%).

After adjustment, the difference in access site complications remained significant, but the difference in major bleeding was no longer significant.

"Our study," continued Dr. Airaksinen, "shows that PCI is a safe procedure during uninterrupted therapeutic warfarin anticoagulation with no excess bleeding or thrombotic complications compared with standard recommendation for these patients -- to discontinue warfarin before invasive cardiac procedures and use low-molecular-weight heparin bridging."

"This simple strategy," he added, "leads to considerable cost savings compared with the conventional bridging therapy, since the majority of PCIs are currently performed because of acute coronary syndromes."

"The optimal perioperative strategy for treating patients requiring warfarin," he concluded, "is, however, complex and will depend on individual patient's risk factors for thromboembolism and bleeding."

Eur Heart J 2008;29:1001-1010.