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

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 OAC s within 30 days of PCI . Outcomes included in‐hospital bleeding and mortality. Of 9566 PCI s, 837 patients (8.8%) were on OAC s, 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 OAC s 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.