Use of Oral Anticoagulation at Time of PCI Surgery Linked To Increase in Adverse Events Interview with:

Eric A. Secemsky, MD MSc Interventional Cardiology Fellow Massachusetts General Hospital, Harvard Medical School Fellow, Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center

Dr. Eric A. Secemsky

Eric A. Secemsky, MD MSc
Interventional Cardiology Fellow
Massachusetts General Hospital
Harvard Medical School
Fellow, Smith Center for Outcomes Research in Cardiology
Beth Israel Deaconess Medical Center What is the background for this study?

Response: Use of oral anticoagulant (OAC) therapy prior to coronary stenting is a significant predictor of post-procedural bleeding events. Previous studies have estimated that the frequency of chronic OAC use among patients undergoing percutaneous coronary intervention (PCI) is between 3% to 7%. Yet many of these analyses examined select patient populations, such as those admitted with acute myocardial infarction or atrial fibrillation, and preceded the market approval of non-vitamin K antagonist oral anticoagulants (NOACs). As such, the contemporary prevalence of OAC use among all-comers undergoing PCI, as well as associated risks of adverse events, are currently unknown.

Therefore, we used PCI data from a large, integrated healthcare system to determine current use of  oral anticoagulant use among all-comers undergoing coronary stenting and the related short- and long-term risks of therapy. What are the main findings?

Response: Our study had the following notable findings.

  • First, among 9,566 PCIs performed during the study period, 8.8%, or 1 in 11 patients, were on chronic OAC therapy.
  • Second, NOACs were increasingly used during the study period (16% of all OACs by the end of the study), yet there was no significant change in the overall number of patients treated with  oral anticoagulant undergoing PCI.
  • Third, patients on OAC therapy experienced a 50% increased risk in-hospital bleeding and 40% greater need for rehospitalization within 90 days relative to those not on OACs.
  • Lastly, patients on oral anticoagulant therapy had a significant long-term risk of mortality, with a 36% increased risk of all-cause death at 4 years. What should readers take away from your report?

Response: Patients on chronic OAC therapy frequently undergo PCI and are more often using NOAC agents. Use of OAC therapy at the time of PCI is an important prognostic marker of adverse events and long-term survival. What recommendations do you have for future research as a result of this study?

Response: Targeted efforts are needed to reduce the occurrence of adverse events following PCI in this population. This includes further investigation into the effects of bleeding reduction strategies, such as increasing rates of radial access and limiting the duration of exposure to triple therapy, on post-PCI outcomes. In addition, determination of the causes of readmission is critical to identifying interventions to reduce the high associated rates of rehospitalization. Thank you for your contribution to the community.


Use of Chronic Oral Anticoagulation and Associated Outcomes Among Patients Undergoing Percutaneous Coronary Intervention

Eric A. Secemsky, Neel M. Butala, Uri Kartoun, Sadiqa Mahmood, Jason H. Wasfy, Kevin F. Kennedy, Stanley Y. Shaw, and Robert W. Yeh

J Am Heart Assoc. 2016;5:e004310, originally published October 17, 2016,doi:10.1161/JAHA.116.004310

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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