Performing diagnostic radial access coronary angiography on uninterrupted direct oral anticoagulant therapy: a prospective analysis

Transradial access has long been championed as the safer route for those undergoing diagnostic coronary angiography or percutaneous coronary interventions (PCI). Numerous studies have established its overall safety even in the context of an acute ST-elevation myocardial infarction (STEMI).1 2 However, little data exist on the safety of transradial access in those on direct oral anticoagulants (DOAC). Conventionally, many interrupt these agents prior to coronary intervention irrespective of the access site selected. There is concern, however, that interrupting anticoagulation for those at high risk poses an unacceptable risk of stroke and embolisation. There is equal concern that continued anticoagulation increases bleeding, both access and non-access sites. Several trials have already determined the safety of cardiac catheterisation with continued vitamin K antagonists.3–6 Currently, there is paucity of randomised data shaping guidelines and practice regarding continued direct oral anticoagulation prior to cardiac catheterisation. The Perioperative Anticoagulant Use for Surgery Evaluation study is an ongoing randomised prospective trial with highly anticipated results. It is designed to address the unanswered question of the safety of interrupting DOAC for atrial fibrillation before elective surgery/procedure. This study includes three parallel cohorts, one for each DOAC. The type of DOAC, renal function and surgery/procedure-related bleeding risk are factored int. The secondary aim is to determine the effect of the preprocedure interruption on residual anticoagulation when measured by the dilute thrombin time …