Coronary artery disease
Safety of Diagnostic Coronary Angiography During Uninterrupted Therapeutic Warfarin Treatment

https://doi.org/10.1016/j.amjcard.2008.04.003Get rights and content

Long-term warfarin therapy is assumed to increase bleeding and access site complications after coronary angiography and it is often recommended to postpone invasive procedures to reach international normalized ratio (INR) levels <1.8. To assess the safety and feasibility of diagnostic coronary angiography during uninterrupted warfarin therapy, we retrospectively analyzed all consecutive patients (n = 258) on warfarin therapy referred for diagnostic coronary angiography in 2 centers with long experience in uninterrupted warfarin therapy during coronary angiography and in 1 center with a policy of preprocedural warfarin pause. An age- and gender-matched control group (n = 258) with similar disease presentation (unstable or stable symptoms) was collected from each center. Radial access was used in 56% of patients in the warfarin group and in 60% of controls (p = 0.21). There was no difference in access site and bleeding complications (1.9% vs 1.6%) or major adverse cardiovascular and cerebrovascular events (0.4% vs 0.8%) between the warfarin group and their controls. Warfarin was interrupted in 80 patients (31%), and bridging therapy was used in 24 of these patients (30%). INR levels were higher in the uninterrupted warfarin group (2.3 vs 1.9, p <0.001), but the incidence of access site complications was not higher (1.7%) than in patients (n = 80) with a warfarin pause (2.5%) or in patients with pause and bridging therapy (8.3%). Need for blood transfusions (n = 2) occurred only in patients with bridging therapy. Access site complications were more common in the 22 patients with supratherapeutic anticoagulation (INR >3) than in patients with therapeutic periprocedural INR (9.1% vs 1.5%, p <0.05). In conclusion, a simple strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation is a tempting alternative to bridging therapy and is likely to lead to considerable cost savings.

Section snippets

Methods

The present study is based on computerized databases in 3 hospitals and is part of a research program in progress to assess thrombotic and bleeding complications of cardiac procedures in western Finland.8, 9 We analyzed retrospectively all consecutive patients on long-term warfarin therapy (n = 258) referred for coronary angiography from 2003 through 2005. In addition, we collected an age- (±5 years) and gender-matched control group with similar indication (acute/elective) for coronary

Results

A total of 258 patients with an indication of long-term warfarin therapy underwent coronary angiography during the study period. Baseline clinical characteristics of the study population and indications for coronary angiography are presented in Table 1. Aspirin, clopidogrel, and low-molecular-weight heparins were more often used in the control group. Femoral access was used in 44% of patients in the warfarin group and in 40% of controls with no difference in the use of closure devices. Atrial

Discussion

Our results suggest that uninterrupted therapeutic warfarin treatment does not predispose a patient to excessive bleeding or access site complications during coronary angiography. However, supratherapeutic INR levels seem to be associated with access site complications. Of note, the 2 major bleeding events leading to blood transfusions occurred in patients with concomitant low-molecular-weight heparin therapy.

It is estimated that 5% of patients undergoing coronary angiography are on long-term

References (19)

There are more references available in the full text version of this article.

Cited by (52)

  • 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

    2016, International Journal of Cardiology
    Citation Excerpt :

    Of those, 23 were further excluded as not pertinent to the design of the meta-analysis or not meeting the explicit inclusion criteria. One RCT and 7 published observational studies [14–22] enrolling N = 2325 patients were eventually included in the analysis. S3 Table lists detailed findings on the bias assessment.

View all citing articles on Scopus

This study was supported by grants from the Finnish Foundation for Cardiovascular Research, Helsinki, Finland.

View full text