Direct Oral Anticoagulants Affect Activated Clotting Time During and Bleeding Events After Percutaneous Coronary Intervention

Abstract

ABSTRACTBackgroundInappropriately high activated clotting time (ACT) during percutaneous coronary intervention (PCI) is associated with an increased risk of bleeding events. However, whether the prescription of direct oral anticoagulants (DOAC) affects ACT kinetics during heparin use and adverse clinical events in patients undergoing PCI remains unclear. To evaluate the ACT changes during and adverse clinical events after PCI in patients who were prescribed DOAC.MethodsThis observational study included 246 patients undergoing PCI at the two cardiovascular centers who were not receiving warfarin and whose ACT was recorded immediately before and 30 min after injection of unfractionated heparin (UFH). Patients were divided into two groups according to DOAC prescription at the time of the index PCI: DOAC users (n=31) and non-users (n=215). Any bleeding and systemic thromboembolic events were investigated until 30 days after PCI.ResultsThe average age of this population was 70.5 years, and 66.3% were male. Average ACT was significantly higher in DOAC users than non-users both before and 30 min after UFH induction (157.2 ± 30.1 vs. 131.8 ± 25.1 sec, p<0.001; 371.1 ± 122.2 vs. 308.3 ± 82.2 sec, p<0.001; respectively). The incidence of post-PCI systemic thromboembolism was low and comparable between the two groups (0% vs. 3.7%, p=0.60). However, the rate of any bleeding event was significantly higher in DOAC users than non-users (16.1% vs. 4.7%, p=0.028).ConclusionPatients receiving DOAC have higher ACTs during PCI and higher incidence of bleeding events than those not receiving DOAC.CONDENSED ABSTRACTChanges in activated clotting time (ACT) and incidence of systemic thromboembolic and bleeding events in patients undergoing percutaneous coronary intervention (PCI) using conventional heparin were compared between those receiving direct oral anticoagulants (DOAC) and those who were not. ACT both before and 30 min after initial heparin injection was higher in patients who received DOAC than in those who did not. DOAC prescription did not affect the incidence of systemic thromboembolic events. Conversely, patients receiving DOAC more frequently experienced post-PCI bleeding events than those not receiving DOAC.