AJC: Warfarin safe, cost-effective during coronary angiography

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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, according to a study published in the Aug. 15 issue of the American Journal of Cardiology.

To assess the safety and feasibility of diagnostic coronary angiography during uninterrupted warfarin (Comadin from DuPont) therapy, the researchers retrospectively analyzed all 258 consecutive patients on warfarin therapy referred for diagnostic coronary angiography in two centers with long experience in uninterrupted warfarin therapy during coronary angiography and in one center with a policy of pre-procedural warfarin pause.

Antti-Pekka Annala, MD, from the department of cardiology at Satakunta Central Hospital in Pori, Finland, and colleagues collected an age- and gender-matched control group with similar disease presentation (unstable or stable symptoms) from each center.

The investigators said that they used radial access in 56 percent of patients in the warfarin group and in 60 percent of controls.

There was no difference in access site and bleeding complications (1.9 vs. 1.6 percent) or major adverse cardiovascular and cerebrovascular events (0.4 vs. 0.8 percent) between the warfarin group and their controls. Warfarin was interrupted in 80 patients, and bridging therapy was used in 24 of these patients, the authors wrote.

According to researchers, international normalized ratio (INR) levels were higher in the uninterrupted warfarin group (2.3 vs. 1.9), but the incidence of access site complications was not higher (1.7 percent) than in 80 patients with a warfarin pause (2.5 percent) or in patients with pause and bridging therapy (8.3 percent). Two patients needed blood transfusions with bridging therapy.

Annala and colleagues found that access site complications were more common in the 22 patients with supratherapeutic anticoagulation (INR >3) than in patients with therapeutic peri-procedural INR (9.1 vs. 1.5 percent).

“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,” the authors concluded.

Finnish Foundation for Cardiovascular Research in Helsinki, Finland, provided the grant that supported the study.