IWANAMI Yuji
   Department   School of Medicine(Tokyo Women's Medical University Adachi Medical Center), School of Medicine
   Position   Assistant Professor
Language English
Title Prescription of Direct Oral Anticoagulant Affects Activated Clotting Time During Percutaneous Coronary Intervention and Clinical Outcomes
Conference American Heart Association (AHA) Scientific Sessions 2018
Promoters American Heart Association
Conference Type International society and overseas society
Presentation Type Poster notice
Lecture Type General
Publisher and common publisher◎EBIHARA Suguru, JUJO Kentaro, KAMISHIMA Kazuho, SHIMAZAKI Kensuke, MORIYAMA Tetsu, SHIOZAKI Natsuko, INAGAKI Keiko, IWANAMI Yuji, ISHIDA Issei, SUZUKI Kazuhito, SAITO Katsumi, HAGIWARA Nobuhisa
Date 2018/11/11
Venue
(city and name of the country)
Chicago, USA
Society abstract Circulation 138(Suppl 1),Abstract 12926 2018
Summary 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.