Additional heparin unnecessary for anticoagulated patients undergoing PCI
MedWire News: Additional heparin does not provide any benefit over uninterrupted therapeutic oral anticoagulation (OAC) for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), Finnish researchers report.
In fact, adding heparin to OAC may increase the risk for procedural complications in these patients, Kari Airaksinen (Turku University Hospital) and colleagues remark.
They explain that current guidelines recommend bridging therapy with unfractionated heparin or low molecular weight heparin (LMWH) during coronary angiography and PCI for patients on long-term warfarin treatment for AF.
Recent studies have shown that uninterrupted OAC could replace heparin bridging because of a favorable balance between bleeding and thrombotic complications, but it is unclear whether additional heparins are needed in patients undergoing PCI during therapeutic OAC.
To investigate, Airaksinen and team assessed bleeding complications and major adverse cardiac and cerebrovascular events in 414 consecutive patients with AF undergoing PCI during therapeutic (international normalized ratio 2.0 to 3.5) periprocedural OAC.
Patients were divided into those with (n=218) and without (n=196) additional use of periprocedural heparin.
As reported in the American Journal of Cardiology, the researchers detected no significant differences in major adverse cardiac and cerebrovascular events (3.2 vs 4.1%) or major bleeding (3.7 vs 1.0%) between patients who did and did not receive heparin.
By contrast, site complications, including pseudoaneurysm or arteriovenous fistula, occurrence of retroperitoneal hemorrhage, and need for corrective surgery, were significantly more frequent in the patients who received heparin, compared with those who did not (11.0 vs 5.1%).
Because treatment groups differed in baseline and procedural variables, the researchers performed a propensity score analysis to control for all known patient factors that might be related to the decision to perform PCI with or without heparin.
When adjusted for propensity score, patients with additional heparin had a significant three-fold higher risk for access site complications compared with patients who did not receive heparin. This risk increased to five-fold in the subgroup of patients who received prolonged (>12 hours) use of heparin together with femoral access.
The propensity score analysis did not, however, show any significant differences between the two groups in myocardial infarction, mortality, target vessel revascularization, stent thrombosis, stroke, and major adverse cardiac and cerebrovascular events.
Airaksinen and co-authors say that their data "may be used to guide the treatment of patients with an indication of long-term OAC undergoing PCI."
They conclude: "Although no estimate of cost was included in our study, it seems obvious that the total cost of the procedure would be higher in the group receiving 'double' [anticoagulation] therapy because of the extra cost of medication and a potentially prolonged stay in hospital because of increased access site complications."
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By Laura Cowen