接受经皮冠状动脉介入治疗患者的口服抗凝治疗围手术期管理：来自PERSEO多中心注册研究的见解
Peri-Procedural Management of Oral Anticoagulant Therapy in Patients Undergoing Percutaneous Coronary Intervention: Insights from the PERSEO Multicenter Registry.
作者信息
Rigattieri Stefano, Cristiano Ernesto, De Rosa Salvatore, Calabrò Paolo, Talarico Giovanni Paolo, Cortese Bernardo, Caruso Marco, Redivo Marco, Musumeci Giuseppe, Sciahbasi Alessandro
机构信息
Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy.
Humanitas Gavazzeni clinic, Bergamo, Italy.
出版信息
Catheter Cardiovasc Interv. 2025 Aug;106(2):1177-1186. doi: 10.1002/ccd.31657. Epub 2025 Jun 4.
BACKGROUND
The optimal management of patients on oral anticoagulant therapy (OAT) undergoing percutaneous coronary intervention (PCI) remains debated. There are three possible strategies: performing the procedure on OAT, bridging OAT with heparins or stopping OAT.
METHODS
In this sub-analysis of the PERSEO multicenter registry, we selected a cohort of patients on OAT undergoing PCI and we appraised in-hospital outcomes according to three different peri-procedural strategies: uninterrupted OAT, interrupted OAT, and interrupted OAT with bridging therapy.
RESULTS
The study population consisted of 763 patients, of whom 76% were receiving direct oral anticoagulants (DOACs) whereas the remaining were on vitamin K antagonists (VKAs). OAT was interrupted in 70%, bridged in 24% and continued in 6% of patients, the latter mainly undergoing emergent procedures. The overall rates of major adverse cardiac and cerebrovascular events and bleedings were 1.7% and 6.8%, respectively. The overall rate of thromboembolic events was very low (0.1%), even in patients who interrupted OAT (0.2%). Bridging strategy (OR 2.39, 95% CI 1.12-5.09), increasing age (OR 1.07, 95% CI 1.02-1.12) and white blood cell count (OR 1.17, 95% CI 1.07-1.27) were independently associated with bleedings, whereas radial approach was a protective factor (OR 0.36, 95% CI 0.17-0.77). Continued anticoagulation (bridging therapy or OAT) was also an independent predictor of bleedings (OR 2.22, 95% CI 1.21-4.08).
CONCLUSIONS
In this study, OAT interruption was a safe strategy for both bleedings and thromboembolic events, whereas continued anticoagulation, especially bridging, was associated with increased bleeding rate. Radial approach should be preferred in this clinical setting.
TRIAL REGISTRATION
The PERSEO study was registered on ClinicalTrials.gov with the ID NCT03392948 (last update 2022-07-22).
背景
接受经皮冠状动脉介入治疗（PCI）的口服抗凝治疗（OAT）患者的最佳管理方案仍存在争议。有三种可能的策略：在OAT治疗期间进行手术、用肝素桥接OAT或停用OAT。
方法
在PERSEO多中心注册研究的这项亚分析中，我们选择了一组接受OAT且正在接受PCI的患者，并根据三种不同的围手术期策略评估住院结局：不间断OAT、中断OAT以及中断OAT并采用桥接治疗。
结果
研究人群包括763例患者，其中76%正在接受直接口服抗凝剂（DOACs）治疗，其余患者使用维生素K拮抗剂（VKAs）。70%的患者中断了OAT，24%的患者采用了桥接治疗，6%的患者继续使用OAT，后者主要接受急诊手术。主要不良心脑血管事件和出血的总体发生率分别为1.7%和6.8%。血栓栓塞事件的总体发生率非常低（0.1%），即使在中断OAT的患者中也是如此（0.2%）。桥接策略（比值比2.39，95%置信区间1.12 - 5.09）、年龄增加（比值比1.07，95%置信区间1.02 - 1.12）和白细胞计数（比值比1.17，95%置信区间1.07 - 1.27）与出血独立相关，而桡动脉入路是一个保护因素（比值比0.36，95%置信区间0.17 - 0.77）。持续抗凝（桥接治疗或OAT）也是出血的独立预测因素（比值比2.22，95%置信区间1.21 - 4.08）。
结论
在本研究中，对于出血和血栓栓塞事件，中断OAT是一种安全的策略，而持续抗凝，尤其是桥接治疗，与出血率增加相关。在这种临床情况下，应优先选择桡动脉入路。
试验注册
PERSEO研究已在ClinicalTrials.gov上注册，注册号为NCT03392948（最后更新时间为2022年7月22日）。
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