Key result
Uninterrupted direct oral anticoagulant therapy resulted in low rates of major bleeding and no increase in thromboembolic events during percutaneous coronary interventions via radial access.
Why the study?
Does uninterrupted DOAC therapy compared to interrupted DOAC therapy improve safety and prevent bleeding or thromboembolism in patients undergoing percutaneous coronary and structural interventions?
Does uninterrupted DOAC therapy compared to interrupted DOAC therapy improve safety and prevent bleeding or thromboembolism in patients undergoing percutaneous coronary and structural interventions?
A patient- and procedure-specific approach to DOAC management is proposed, favoring uninterrupted DOAC for uncomplicated radial PCI and short-term interruption for structural interventions with higher bleeding risk.
Answers are grounded in this paper and cite their sources.
May support uninterrupted DOAC in radial PCI; leaves open RCTs for structural interventions.
The management of direct oral anticoagulants (DOAC) during percutaneous coronary interventions is a common challenge in clinical practice. The periprocedural management remains highly variable and insufficiently evidence-based. This review summarizes the pharmacokinetic properties of DOACs, evaluates contemporary guideline recommendations and examines observational and prospective evidence for interruption versus continuation strategies in coronary and structural interventions. For percutaneous coronary interventions, predominantly via radial-access, observational evidence suggests that uninterrupted DOAC therapy is associated with low rates of bleeding and thromboembolism. Questioning the routine practice of pre-procedural interruption in low-risk cases. In contrast, patients undergoing transcatheter structural interventions are older, requiring femoral access and at a higher baseline bleeding risk. In this setting, recent data do not support routine continuation of anticoagulation. We propose a patient and procedure-specific approach to DOAC management that prioritizes access site, procedural complexity and renal function over uniform interruption protocols. There is a need for targeted prospective randomized studies on periprocedural and immediate postprocedural management in these populations.
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Jones et al. (2026) conducted a review in Patients undergoing percutaneous coronary intervention or transcatheter structural interventions receiving direct oral anticoagulants. Uninterrupted direct oral anticoagulants (DOAC) therapy vs. Interrupted DOAC therapy was evaluated on Rate of major bleeding and thromboembolic events during and after percutaneous coronary interventions (Major bleeding approximately 1% with uninterrupted DOAC in prospective studies). Uninterrupted direct oral anticoagulant therapy resulted in low rates of major bleeding and no increase in thromboembolic events during percutaneous coronary interventions via radial access.
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