NEW YORK (Reuters Health), Sep 9 - The results of a new study suggest that patients receiving long-term warfarin therapy do not need to stop the drug prior to coronary angiography.
According to the report in the American Journal of Cardiology for August 15, continued warfarin therapy does not increase the risk of bleeding or access-site complications, provided that INR levels are not supratherapeutic.
Guidelines typically recommend that warfarin-treated patients stop the drug and achieve INR levels of less than 1.8 before undergoing invasive procedures, Dr. K. E. Juhani Airaksinen, from Turku University Hospital in Finland, and colleagues explain. Bridging therapy with low-molecular-weight heparin is usually given during the procedure until the INR is restored to therapeutic levels, the authors note.
The down side of this bridging therapy, however, is that it may prolong hospitalization and increase the risk of thromboembolism. In the present study, the researchers compared the outcomes of 258 warfarin-treated patients with those of 258 controls who underwent coronary angiography. The subjects were matched for age, gender, and disease presentation.
The warfarin group included 178 patients who received uninterrupted warfarin and 80 who had the drug interrupted, including 24 in whom bridging therapy was instituted.
In the overall analysis, the warfarin group was not significantly different from the control group in the rate of access site and bleeding complications (1.9% versus 1.6%) and the rate of major adverse cardiovascular and cerebrovascular events (0.4% versus 0.8%).
In the warfarin group, the INR level was higher with uninterrupted warfarin therapy, but this did not translate into an increased risk of access site or bleeding complications. An INR level greater than 3, however, did increase the odds of access site complications relative to a therapeutic INR (2 to 3): 9.1% versus 1.5% (p < 0.05).
"A simple strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation is a tempting alternative to bridging therapy and is likely to lead to considerable cost savings," the authors conclude.
Am J Cardiol 2008;102:386-390.
Last Updated: 2008-09-09 8:30:36 -0400 (Reuters Health)
Related Reading
Long-term anticoagulant users show elevated coronary, aortic calcium, December 2, 2005
Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
![Overview of the study design. (A) The fully automated deep learning framework was developed to estimate body composition (BC) (defined as subcutaneous adipose tissue [SAT] in liters; visceral adipose tissue [VAT] in liters; skeletal muscle [SM] in liters; SM fat fraction [SMFF] as a percentage; and intramuscular adipose tissue [IMAT] in deciliters) from MRI. The fully automated framework comprised one model (model 1) to quantify different BC measures (SAT, VAT, SM, SMFF, and IMAT) as three-dimensional (3D) measures from whole-body MRI scans. The second model (model 2) was trained to identify standardized anatomic landmarks along the craniocaudal body axis (z coordinate field), which allowed for subdividing the whole-body measures into different subregions typically examined on clinical routine MRI scans (chest, abdomen, and pelvis). (B) BC was quantified from whole-body MRI in over 66,000 individuals from two large population-based cohort studies, the UK Biobank (UKB) (36,317 individuals) and the German National Cohort (NAKO) (30,291 individuals). Bar graphs show age distribution by sex and cohort. BMI = body mass index. (C) After the performance assessment of the fully automated framework, the change in BC measures, distributions, and profiles across age decades were investigated. Age-, sex-, and height-adjusted body composition reference curves were calculated and made publicly available in a web-based z-score calculator (https://circ-ml.github.io).](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/05/body-comp.XgAjTfPj1W.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
