Contemporary anticoagulation therapy in patients undergoing percutaneous intervention

Abstract

The proper use of anticoagulants is crucial for ensuring optimal patient outcomes post percutaneous interventions in the cardiac catheterization laboratory. Anticoagulant agents such as unfractionated heparin, a thrombin inhibitor; low-molecular weight heparins, predominantly Factor Xa inhibitors; fondaparinux, a Factor Xa inhibitor and bivalirudin, a direct thrombin inhibitor have been developed to target various steps in the coagulation cascade to prevent formation of thrombin. Optimal anticoagulation achieves the correct balance between thrombosis and bleeding and is related to optimal outcomes with minimal complications. This review will discuss the mechanisms and appropriate use of current and emerging anticoagulant therapies used during percutaneous interventions.

Keywords::

• anticoagulation
• cardiac catheterization
• percutaneous coronary intervention
• percutaneous endovascular intervention

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The use of anticoagulants therapy during percutaneous intervention has been refined over the years, with the goal of improving clinical outcomes and minimizing bleeding.

• Heparin is the most used agent for anticoagulation during percutaneous interventions but other agents such as low molecular weight heparin and bivalirudin are becoming more popular.

• The search for the ideal anticoagulant that is more effective but causes less bleeding compared with heparin continues, but studies with the newer anticoagulants such as dabigatran and otamixaban have been disappointing, while other design drugs such as M118 have had encouraging results.

• The evidence base for peripheral interventions and for structural interventions also needs to be expanded.

• The current issues are related to minimizing the risk of bleeding and identifying the optimal way to anticoagulate patients who are on one of the newer anticoagulants in the acute setting and after discharge.

Notes