Performing diagnostic radial access coronary angiography on uninterrupted direct oral anticoagulant therapy: a prospective analysis

Abstract

PurposeWe sought to assess the safety of performing diagnostic radial access coronary angiography with uninterrupted anticoagulation on patients receiving direct oral anticoagulant therapy.BackgroundDirect oral anticoagulants have become a popular choice for the prevention of thromboembolism. Risk factors for thromboembolism are common among cardiovascular conditions and indications for direct oral anticoagulant therapy as well as coronary angiography often overlap in patients. It has been hypothesised that uninterrupted direct oral anticoagulant therapy would increase haemorrhagic and access site complications, however data in this area is limited.MethodsThis was a prospective observational analysis of 49 patients undergoing elective diagnostic coronary angiography while receiving uninterrupted anticoagulation with direct oral anticoagulants. This population was compared with a control group of 49 unselected patients presenting to the cardiology service for elective diagnostic coronary angiography. Continuous variables were analysed using the independent samples t-test and categorical variables using Pearson’s χ2 test.ResultsThe mean duration of radial compression for the control group was 235.8±62.8 min and for the uninterrupted direct oral anticoagulant group was 258.4±56.5 min. There was no significant difference in mean duration of radial compression (p=0.07; 95% CI=-1.4 to 46.5). There was also no difference in the complication rate between the two groups (p=1).ConclusionsWe observed similar complication rates and radial artery compression time postangiography in both groups. This small prospective observational study suggests that uninterrupted continuation of direct oral anticoagulants during coronary angiography is safe. Larger randomised control studies in this area would be beneficial.

Assessment of Blood Loss during Neuroendovascular Procedures

“…However, in a large meta-analysis of patients undergoing cardiovascular endovascular interventions, uninterrupted warfarin was not associated with higher odds of major bleeding compared to interrupted warfarin [18]. Similarly, a prospective analysis involving 49 patients demonstrated that those on uninterrupted direct oral anticoagulants (DOACs) during elective transradial coronary angiography did not have a difference in bleeding (overall 0% major and minor hemorrhage risks in both groups) compared to those not on DOACs [19]. This is worth further clarifying, as almost half of our sample was on a pre-operative anticoagulant/antiplatelet agent, and rates of oral anticoagulant use have been increasing among Medicare beneficiaries [20].…”

Antithrombotic Therapy in Patients with Atrial Fibrillation and Acute Coronary Syndrome

“…For NOACs, less data are available. Observational data suggest that both continuation and omittance one day preprocedure may be safe [ 45 , 46 ]. A study comparing patients with AF undergoing primary PCI for STEMI found no difference with regards to in-hospital major bleeding between patients admitted without OAC and those admitted on chronic VKA or NOAC treatment (13.2% vs. 13.0% vs. 11.6%, respectively, p = 0.57) [ 47 ].…”

Performing diagnostic radial access coronary angiography on uninterrupted direct oral anticoagulant therapy: a prospective analysis

“…Chongprasertpon and colleagues also address this pressing topic in their publication 8. This is a prospective study of 49 patients who underwent transradial coronary angiography while on chronic anticoagulant therapy and 49 controls who were not anticoagulated.…”