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Anticoagulation before PCI fails to improve outcomes in non-STEMI
Among patients with non-STEMI undergoing PCI, parenteral anticoagulation therapy before the procedure did not lower risk for death or MI and increased risk for bleeding, according to new findings.
The researchers conducted a retrospective cohort study of 8,197 adults with non-STEMI (mean age, 64 years; 75% men) who underwent PCI at five centers in China between 2010 and 2014.
Patients were stratified by whether they received anticoagulation before or during PCI. The before-PCI group mainly received unfractionated heparin. The during-PCI group received fondaparinux or low-molecular-weight heparin.
The primary outcomes were in-hospital mortality and in-hospital major bleeding, defined as Bleeding Academic Research Consortium grades 3 to 5.
In-hospital mortality occurred in 0.3% of the before-PCI group and 0.1% of the during-PCI group (adjusted OR = 1.27; 95% CI, 0.38-4.27), Ji-Yan Chen, MD, PhD, from the department of cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China, and colleagues wrote.
In-hospital MI occurred in 0.3% of both groups (aOR = 0.77; 95% CI, 0.29-2.07), according to the researchers.
However, the before-PCI group had a higher rate of in-hospital major bleeding (2.5% vs. 1%; aOR = 1.94; 95% CI, 1.24-3.03), the researchers wrote.
At a median follow-up of nearly 3 years, there was no difference between the groups in all-cause death (adjusted HR = 0.87; 95% CI, 0.71-1.07), but the before-PCI group had greater risk for major bleeding (aHR = 1.43; 95% CI, 1.01-2.02), Chen and colleagues found.
Propensity-score matching did not change the results.
“These findings raise important safety questions about the current practice of routine parenteral anticoagulation therapy while we await randomized trials of this practice,” Chen and colleagues wrote. – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.