The management of patients on oral anticoagulation undergoing coronary stent implantation: a survey among interventional cardiologists from eight european countries
Journal of Interventional Cardiology, 05/07/2012  Clinical Article

Rubboli A et al. – Among the 202 interventional cardiologists from the 8 European countries interviewed, the management of patients on oral anticoagulation (OAC) undergoing PCI–S appears variable and only partially adherent to currently available recommendations.

• By means of a contact person who had been previously identified in 8 European countries, a questionnaire was electronically forwarded between April and July 2010 to the national institutions where PCI–S is performed.

• A total of 202 questionnaires (median response rate: 50%, range 33–78%) was received.
• The prevalence of OAC patients among those undergoing PCI–S is mostly reported 5–10% (97%).
• The peri–procedural pharmacological management mostly encompasses: preprocedural OAC interruption and bridging with low–molecular–weight heparin (59%), intraprocedural administration of an unfractionated heparin bolus (81%), and use of glycoprotein IIb/IIIa inhibitors on an individual basis (79%).
• The radial approach is reported as the preferred option (58%), as well as the implantation of bare metal stents (76%).
• Triple therapy (warfarin, aspirin, clopidogrel) is the most frequently prescribed (80%), generally for 1 month after bare metal stent (77%) and for at least 12 months after drug–eluting stent (60%).
• Throughout triple therapy, the International Normalized Ratio is mostly targeted to the lower end of the therapeutic range (77%), and gastric protection is routinely prescribed (69%), mostly by giving proton–pump inhibitors (70%).