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

Mariusz Kowalewski; Piotr Suwalski; Giuseppe Maria Raffa; Artur Słomka; Magdalena Ewa Kowalkowska; Krzysztof Aleksander Szwed; Alina Borkowska; Janusz Kowalewski; Pietro Giorgio Malvindi; Anetta Undas; Jerzy Windyga; Wojciech Pawliszak; Lech Anisimowicz; Thierry Carrel; Domenico Paparella; Gregory Y H Lip

doi:10.1016/j.ijcard.2016.08.089

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

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

Authors

Mariusz Kowalewski¹, Piotr Suwalski², Giuseppe Maria Raffa³, Artur Słomka⁴, Magdalena Ewa Kowalkowska⁵, Krzysztof Aleksander Szwed⁶, Alina Borkowska⁶, Janusz Kowalewski⁷, Pietro Giorgio Malvindi⁸, Anetta Undas⁹, Jerzy Windyga¹⁰, Wojciech Pawliszak¹¹, Lech Anisimowicz¹¹, Thierry Carrel¹², Domenico Paparella¹³, Gregory Y H Lip¹⁴

Affiliations

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.

PMID: 27541652
DOI: 10.1016/j.ijcard.2016.08.089

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.

Publication types

Comparative Study
Meta-Analysis
Review

MeSH terms

Administration, Oral
Anticoagulants / therapeutic use*
Coronary Angiography*
Drug Administration Schedule
Humans
Percutaneous Coronary Intervention*

Substances

Anticoagulants