Author + information
- Ashraf M. Al Azzoni,
- Ellen Macrae,
- Syal Renu,
- Hussain Alzayer,
- Chandni Patel,
- Jon-David Schwalm,
- Sanjit Jolly and
- Madhu Natarajan
Background: The number of patients on chronic anticoagulation with Warfarin as well as Novel Oral Anticoagulants (NOACs) is increasing. At the same time, more patients on chronic anticoagulation are needing percutaneous coronary interventional (PCI) procedures. Our study aim was to assess the current risks associated with performing PCI while on Warfarin or NOACs with a focus on vascular access complications.
Methods: SMART-AMI is a registry of patients presenting with ST-Elevation Myocardial Infarction (STEMI) to a large tertiary care center in Ontario, Canada. We retrospectively analyzed the patients undergoing primary PCI for STEMI while being on an oral anticoagulant (Warfarin or NOAC) and had an emergent PCI. We compared this group with an age- and gender-matched control group (1:2 ratio) from the registry that were not on an anticoagulant on the time of primary PCI. Primary outcomes are major bleeding and major vascular complications.
Results: A total of 132 patients presented with STEMI while being anticoagulated (84 patients (64%) were on Warfarin while 48 patients (36%) were on NOACs). The mean INR in the patients who were on Warfarin was 2.3 on presentation to hospital. The control arm had 264 patients that were not on an anticoagulant on presentation to the hospital. Mean age was 78 years in both groups and 58% of patients were males in each group. The procedure was done using the radial access in 58% versus 52% in the prior anticoagulation group and the control group respectively (P=0.04) while Heparin was given in 80% versus 94% of the patients respectively (P<0.0001). There was no significant difference in the risk of major bleeding between groups (8.3% versus 9.1%, P=0.85). Major vascular complication was identified in 2 patients in each group.
Conclusions: Our results suggest that performing emergency PCI in patients being anticoagulated without interrupting anticoagulation is not associated with excess risk of vascular complications or major bleeding. Whether this option can be extended to other patient groups undergoing PCI including elective cases needs further research.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Vascular Access and Hemostasis Issues
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1192-117
- 2017 American College of Cardiology Foundation