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

View Article: PubMed Central - PubMed

ABSTRACT

Background: Contemporary rates of oral anticoagulant (OAC) therapy and associated outcomes among patients undergoing percutaneous coronary intervention (PCI) have been poorly described.

Methods and results: Using data from an integrated health care system from 2009 to 2014, we identified patients on OACs within 30 days of PCI. Outcomes included in‐hospital bleeding and mortality. Of 9566 PCIs, 837 patients (8.8%) were on OACs, and of these, 7.9% used non–vitamin K antagonist agents. OAC use remained stable during the study (8.1% in 2009, 9.0% in 2014; P=0.11), whereas use of non–vitamin K antagonist agents in those on OACs increased (0% in 2009, 16% in 2014; P<0.01). Following PCI, OAC‐treated patients had higher crude rates of major bleeding (11% versus 6.5%; P<0.01), access‐site bleeding (2.3% versus 1.3%; P=0.017), and non–access‐site bleeding (8.2% versus 5.2%; P<0.01) but similar crude rates of in‐hospital stent thrombosis (0.4% versus 0.3%; P=0.85), myocardial infarction (2.5% versus 3.0%; P=0.40), and stroke (0.48% versus 0.52%; P=0.88). In addition, prior to adjustment, OAC‐treated patients had longer hospitalizations (3.9±5.5 versus 2.8±4.6 days; P<0.01), more transfusions (7.2% versus 4.2%; P<0.01), and higher 90‐day readmission rates (22.1% versus 13.1%; P<0.01). In adjusted models, OAC use was associated with increased risks of in‐hospital bleeding (odds ratio 1.50; P<0.01), 90‐day readmission (odds ratio 1.40; P<0.01), and long‐term mortality (hazard ratio 1.36; P<0.01).

Conclusions: Chronic OAC therapy is frequent among contemporary patients undergoing PCI. After adjustment for potential confounders, OAC‐treated patients experienced greater in‐hospital bleeding, more readmissions, and decreased long‐term survival following PCI. Efforts are needed to reduce the occurrence of adverse events in this population.

No MeSH data available.


Temporal changes in use of NOACs compared with VKAs among patients on chronic OAC therapy undergoing PCI during the study period. Note the brisk increase in use of NOACs in place of VKAs beginning in 2010, which corresponds with the market approval of the first NOAC. NOAC indicates non‐vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant; PCI, percutaneous coronary intervention; VKA, vitamin K antagonist.
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jah31755-fig-0001: Temporal changes in use of NOACs compared with VKAs among patients on chronic OAC therapy undergoing PCI during the study period. Note the brisk increase in use of NOACs in place of VKAs beginning in 2010, which corresponds with the market approval of the first NOAC. NOAC indicates non‐vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant; PCI, percutaneous coronary intervention; VKA, vitamin K antagonist.

Mentions: From June 2009 through September 2014, a total of 9566 PCIs met the inclusion criteria. Of these procedures, 837 (8.8%) were performed in patients with OAC use within 30 days of admission. NOACs were used in 66 (7.9%) of these PCIs, with VKAs used in the remainder. During the study period, overall OAC use remained stable (8.1% of PCIs in 2009, 9.0% in 2014; P=0.11 for trend), whereas NOACs comprised an increasing proportion of all OAC use among PCIs (0% in 2009, 17.6% of OACs in 2014; P<0.01 for trend) (Figure 1). Use of triple therapy (OAC plus a P2Y12 inhibitor and aspirin) at discharge after PCI remained constant during the study period (83.2% in 2009, 83.8% in 2014; P=0.66 for trend) (Figure S1).


Use of Chronic Oral Anticoagulation and Associated Outcomes Among Patients Undergoing Percutaneous Coronary Intervention
Temporal changes in use of NOACs compared with VKAs among patients on chronic OAC therapy undergoing PCI during the study period. Note the brisk increase in use of NOACs in place of VKAs beginning in 2010, which corresponds with the market approval of the first NOAC. NOAC indicates non‐vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant; PCI, percutaneous coronary intervention; VKA, vitamin K antagonist.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121523&req=5

jah31755-fig-0001: Temporal changes in use of NOACs compared with VKAs among patients on chronic OAC therapy undergoing PCI during the study period. Note the brisk increase in use of NOACs in place of VKAs beginning in 2010, which corresponds with the market approval of the first NOAC. NOAC indicates non‐vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant; PCI, percutaneous coronary intervention; VKA, vitamin K antagonist.
Mentions: From June 2009 through September 2014, a total of 9566 PCIs met the inclusion criteria. Of these procedures, 837 (8.8%) were performed in patients with OAC use within 30 days of admission. NOACs were used in 66 (7.9%) of these PCIs, with VKAs used in the remainder. During the study period, overall OAC use remained stable (8.1% of PCIs in 2009, 9.0% in 2014; P=0.11 for trend), whereas NOACs comprised an increasing proportion of all OAC use among PCIs (0% in 2009, 17.6% of OACs in 2014; P<0.01 for trend) (Figure 1). Use of triple therapy (OAC plus a P2Y12 inhibitor and aspirin) at discharge after PCI remained constant during the study period (83.2% in 2009, 83.8% in 2014; P=0.66 for trend) (Figure S1).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Contemporary rates of oral anticoagulant (OAC) therapy and associated outcomes among patients undergoing percutaneous coronary intervention (PCI) have been poorly described.

Methods and results: Using data from an integrated health care system from 2009 to 2014, we identified patients on OACs within 30&nbsp;days of PCI. Outcomes included in&#8208;hospital bleeding and mortality. Of 9566 PCIs, 837 patients (8.8%) were on OACs, and of these, 7.9% used non&ndash;vitamin K antagonist agents. OAC use remained stable during the study (8.1% in 2009, 9.0% in 2014; P=0.11), whereas use of non&ndash;vitamin K antagonist agents in those on OACs increased (0% in 2009, 16% in 2014; P&lt;0.01). Following PCI, OAC&#8208;treated patients had higher crude rates of major bleeding (11% versus 6.5%; P&lt;0.01), access&#8208;site bleeding (2.3% versus 1.3%; P=0.017), and non&ndash;access&#8208;site bleeding (8.2% versus 5.2%; P&lt;0.01) but similar crude rates of in&#8208;hospital stent thrombosis (0.4% versus 0.3%; P=0.85), myocardial infarction (2.5% versus 3.0%; P=0.40), and stroke (0.48% versus 0.52%; P=0.88). In addition, prior to adjustment, OAC&#8208;treated patients had longer hospitalizations (3.9&plusmn;5.5&nbsp;versus 2.8&plusmn;4.6&nbsp;days; P&lt;0.01), more transfusions (7.2% versus 4.2%; P&lt;0.01), and higher 90&#8208;day readmission rates (22.1% versus 13.1%; P&lt;0.01). In adjusted models, OAC use was associated with increased risks of in&#8208;hospital bleeding (odds ratio 1.50; P&lt;0.01), 90&#8208;day readmission (odds ratio 1.40; P&lt;0.01), and long&#8208;term mortality (hazard ratio 1.36; P&lt;0.01).

Conclusions: Chronic OAC therapy is frequent among contemporary patients undergoing PCI. After adjustment for potential confounders, OAC&#8208;treated patients experienced greater in&#8208;hospital bleeding, more readmissions, and decreased long&#8208;term survival following PCI. Efforts are needed to reduce the occurrence of adverse events in this population.

No MeSH data available.