Chapter 21: Management of Patients on Chronic Oral Anticoagulant Therapy

Patients with coronary artery disease frequently have comorbid conditions requiring chronic oral anticoagulant (OAC) therapy, such as atrial fibrillation, valvular heart disease, arterial or venous thromboembolic disease, or left ventricular thrombus. It has been estimated that 5% to 8.5% of patients referred for elective or emergent cardiac catheterization and percutaneous revascularization are on chronic OAC therapy. When cardiac catheterization is performed on patients who are on OAC, there is increased risk of both local and systemic bleeding complications. This risk can be increased even further if coronary intervention is performed due to the need for additional concomitant anticoagulant therapy. The use of femoral vascular closure devices does not reduce the overall risk of bleeding complications. In fact, vascular closure devices have been shown to be a predictor of a major bleeding event after percutaneous revascularization in patients on OAC. In addition, patients are less likely to be treated with a guidelines-indicated early invasive strategy for acute coronary syndrome if they are on chronic OAC.

R. Lee Jobe, MD, FACC, FSCAI