Cardiac catheterization during anticoagulant therapy

Sixty-three patients receiving anticoagulant therapy with sodium warfarin underwent cardiac catheterization with prothrombin-proconvertin values between 4 and 30 percent. The anticoagulant dose was omitted the day before and resumed the evening of catheterization. Procedures included 43 right heart studies by venous cutdown, 26 transseptal left heart catheterizations, 42 percutaneous retrograde femoral arterial catheterizations, 8 transthoracic cardiac punctures and 55 percutaneous brachial arterial catheterizations.

In 1 patient left hemothorax developed after transthoracic cardiac puncture. In a second minor bleeding from the femoral arterial puncture site occurred after premature ambulation. No extensive bleeding or difficulty in obtaining hemostasis occurred. Cardiac catheterization can be performed with reasonable safety during anticoagulant therapy with the prothrombin-proconvertin time in the therapeutic range. Problems in reestablishing anticoagulant control are avoided, and the patient is not exposed to the increased risk of thromboembolic complications incurred with interrupted therapy.