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Int J Cardiol. 2016 Nov 15;223:186-194. doi: 10.1016/j.ijcard.2016.08.089. Epub 2016 Aug 4.

Meta-analysis of uninterrupted as compared to interrupted oral anticoagulation with or without bridging in patients undergoing coronary angiography with or without percutaneous coronary intervention.

Author information

1
Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Poland; Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz, Poland. Electronic address: kowalewskimariusz@gazeta.pl.
2
Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland; Pulaski University of Technology and Humanities, Radom, Poland.
3
Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
4
Department of Pathophysiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
5
Department and Clinic of Obstetrics, Gynecology, and Oncological Gynecology, Collegium Medicum in Bydgoszcz, Poland.
6
Department of Clinical Neuropsychology, Collegium Medicum, Bydgoszcz, Poland Nicolaus Copernicus University, Toruń, Poland.
7
Lung Cancer and Thoracic Surgery Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
8
University Hospital Southampton NHS Foundation Trust, Wessex Cardiothoracic Centre, Southampton, United Kingdom.
9
Institute of Cardiology, Jagiellonian University Medical College, Center for Research and Medical Technology, John Paul II Hospital, Cracow, Poland.
10
Department of Disorders of Hemostasis and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
11
Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Poland.
12
Clinic for Cardiovascular Surgery, University Hospital and University of Bern, Switzerland.
13
Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
14
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.

Abstract

OBJECTIVES:

To assess safety and effectiveness of different periprocedural antithrombotic strategies in patients receiving long-term oral anticoagulation and undergoing coronary angiography with or without percutaneous coronary intervention (PCI).

METHODS:

Studies comparing uninterrupted oral anticoagulation (UAC) with vit. K antagonists vs interrupted oral anticoagulation (IAC) with or without bridging anticoagulation before coronary procedures were eligible for inclusion in the current meta-analysis. Endpoints selected were 30-day composite of major adverse cardiovascular or cerebrovascular and thromboembolic events (MACCE) and major bleeding.

RESULTS:

Eight studies (7 observational and 1 randomized controlled trial [N=2325pts.]) were included in the analysis. There was no difference in MACCE between UAC and IAC; RR (95%CIs): 0.74 (0.34-1.64); p=0.46 but there was a statistically significant MACCE risk reduction with UAC as compared to IAC with bridging: 0.52 (0.29-0.95); p=0.03. Likewise, there were no statistically significant differences between UAC vs IAC in regard to major bleeding: 0.62 (0.16-2.43); p=0.49; but as compared to IAC with bridging, UAC was associated with statistically significant 65% lower risk of major bleeding: 0.35 (0.13-0.92); p=0.03. Additionally, meta-regression analysis revealed significant linear correlation between log RR of MACCE (β=-4.617; p<0.001) and major bleeding (β=6.665; p=0.022) and mean value of target INR suggestive of higher thrombotic and secondary haemorrhagic risk below estimated INR cut-off of 2.17-2.27 within 30days.

CONCLUSIONS:

Uninterrupted OAC is at least as safe as interrupted OAC, and seems to be much safer than interrupted OAC with bridging anticoagulation in patients undergoing coronary angiography with or without PCI.

KEYWORDS:

Atrial fibrillation; Bridging anticoagulation; Heparin; Meta-analysis; Oral anticoagulation; Percutaneous coronary intervention

PMID:
27541652
DOI:
10.1016/j.ijcard.2016.08.089
[Indexed for MEDLINE]

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