Peri-Procedural Management of Oral Anticoagulant Therapy in Patients Undergoing Percutaneous Coronary Intervention: Insights from the PERSEO Multicenter Registry.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

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