イワナミ ユウジ   IWANAMI Yuji
  岩波 裕史
   所属   医学部 医学科(東京女子医科大学病院)
   職種   助教
言語種別 英語
発表タイトル Prescription of Direct Oral Anticoagulant Affects Activated Clotting Time During Percutaneous Coronary Intervention and Clinical Outcomes
会議名 American Heart Association (AHA) Scientific Sessions 2018
主催者 American Heart Association
学会区分 国際学会及び海外の学会
発表形式 ポスター掲示
講演区分 一般
発表者・共同発表者◎EBIHARA Suguru, JUJO Kentaro, KAMISHIMA Kazuho, SHIMAZAKI Kensuke, MORIYAMA Tetsu, SHIOZAKI Natsuko, INAGAKI Keiko, IWANAMI Yuji, ISHIDA Issei, SUZUKI Kazuhito, SAITO Katsumi, HAGIWARA Nobuhisa
発表年月日 2018/11/11
開催地
(都市, 国名)
Chicago, USA
学会抄録 Circulation 138(Suppl 1),Abstract 12926 2018
概要 Session Title: Pharmacotherapies for ACS and PCI

Background: Prior clinical trials suggested that activated clotting time (ACT) should be kept higher than 250 seconds during percutaneous coronary intervention (PCI) to prevent thrombotic complications. However, changes of ACT during PCI in patient receiving direct oral anticoagulant therapy (DOAC) is still unclear.

Hypothesis: Administration of DOAC affects ACT kinetics during the procedure and the following bleeding and thrombotic event rate after PCI.

Methods: Total of 246 patients who underwent PCI in two cardiovascular centers was retrospectively analyzed. Patients were administered 100 IU/kg of initial bolus unfractionated heparin. ACT was tested before and every 30 minutes after initial bolus, and 40 IU/kg of additional heparin was administered if ACT was less than 250 sec. Aspirin and thienopyridine administration were started before PCI and continued after the session. Additionally, bleeding or embolic complications up to 30 days after PCI were compared between patients with and without DOAC at PCI.

Results: Baseline clinical profiles were comparable between DOAC group (n=29) and Non-DOAC group (n=217), except more frequent prior strokes, lower left ventricular ejection fraction, higher brain natriuretic peptide level and higher heart rate in DOAC group. The rate of trans-radial approach was comparable between the groups (79.3% vs. 67.3%, p=0.21). DOAC group had significantly higher ACT at baseline than Non-DOAC group (154±26 vs. 131±24 sec., p<0.001), and this superiority was retained until the end of session (at 30 minutes: 374±129 vs. 303±83 sec., p<0.001, Figure A). In terms of complications, DOAC group showed a significantly higher incidence of any-bleeding (13.8% vs. 3.7%, p=0.039); whereas, comparable in major bleeding, and no thrombotic event in either group (Figure B).

Conclusion: Additional prescription of DOAC to antiplatelet drugs is associated with longer ACT during PCI, and higher bleeding event rate after PCI.