Uninterrupted Oral Anticoagulation Therapy in Unplanned PCI Evaluated in SWEDEHEART Registry

April 12, 2021—An analysis of the SWEDEHEART study investigated oral anticoagulant (OAC) therapy in patients undergoing percutaneous coronary intervention (PCI), specifically comparing interrupted (I-OAC) and uninterrupted (U-OAC) therapy. As noted in the journal summary, the study was motivated by the “paucity of data regarding the optimal periprocedural management of OAC-treated patients.” Dimitrios Venetsanos, MD, et al published the findings in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2021;14:754-763).

The analysis included all patients on OAC in the SWEDEHEART registry who were admitted acutely and underwent PCI or coronary angiography with a diagnostic procedure, from 2005 to 2017. Outcomes were major adverse cardiac and cerebrovascular events (MACCE; death, myocardial infarction, or stroke) and bleeds at 120 days. Propensity score matching was used to adjust for the nonrandomized treatment selection. The study included 6,485 patients with 3,322 in the I-OAC group and 3,163 in the U-OAC group.

As summarized in JACC: Cardiovascular Interventions, the investigators found that I-OAC and U-OAC were associated with equivalent risk for MACCE and bleeding complications. A U-OAC strategy was associated with a shorter length of hospitalization. These data support U-OAC as the preferable strategy in patients on OAC undergoing coronary intervention, concluded the investigators in JACC: Cardiovascular Interventions.

Although the results of the SWEDEHEART registry support the European recommendations, randomized evidence is ideally needed to implement the U-OAC strategy routinely in clinical practice.

In an accompanying editorial in JACC: Cardiovascular Interventions, Piera Capranzano, MD, and Dominick J. Angiolillo, MD, discussed the investigators’ findings, the limitations of the study, and the implications of the study in terms of current recommendations in Europe and the United States (2021;14:764-767). They advised, “Although the results of the SWEDEHEART registry support the European recommendations, randomized evidence is ideally needed to implement the [U-OAC] strategy routinely in clinical practice. Moreover, adoption of the [U-OAC] strategy in patients undergoing PCI is further challenged by the uncertainty surrounding the optimal antithrombotic regimen to be used during the PCI procedure.”