Abstract
Abstract 78: The Association of Home Warfarin Therapy with Acute Treatment Patterns and Bleeding Risk in Patients Presenting with ST-Elevation Myocardial Infarction: Results from the NCDR
Circulation Cardiovascular quality and outcomes, Vol.6(suppl_1)
05/2013
DOI: 10.1161/circoutcomes.6.suppl_1.A78
Abstract
Introduction:
Bleeding complications during acute coronary syndrome care are independent predictors of adverse outcomes. Patients presenting with ST-elevation myocardial infarction (STEMI) receiving warfarin therapy at home represent a management challenge especially in the absence of specific recommendations in current guidelines. Given the paucity of data, this study aims to describe the acute treatment patterns and bleeding risk in STEMI patients treated with primary percutaneous coronary intervention (PCI).
Methods:
We examined 120,270 STEMI patients treated with primary PCI at 586 ACTION Registry
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hospitals between 2007- 2012, excluding patients who died within the first 24 hours. A total of 3,101 patients (2.6%) were on home warfarin. Antiplatelet and anticoagulant regimens within the first 24 hours of admission were compared between patients taking and those not taking warfarin at home. The association between home warfarin therapy and risk of in-hospital major bleeding was analyzed using multivariable logistic generalized estimating equations method.
Results:
STEMI patients on home warfarin were older and had higher prevalence of co-morbid conditions such as hypertension, diabetes, and renal disease compared with those not taking warfarin; at presentation only 35.6% of patients had INR ≥2.0. They were less likely to receive prasugrel and heparin, but more likely to receive clopidogrel and bivalirudin compared with those not on home warfarin (Table). Glycoprotein IIbIIIa inhibitors were also less commonly administered to patients taking warfarin at home (Table). Door-to-balloon ≤90 minutes for direct arrivals and ≤120 minutes for transfers were less likely to be achieved in patients on home warfarin (83.5% vs. 88.5%, p<0.0001 and 47.5% vs. 57.1%, p<0.0001, respectively). Home warfarin therapy was associated with significantly higher risk of in-hospital major bleeding (17.0% vs 10.1%; adjusted odds ratio 1.26 [1.13-1.40]).
Conclusions:
In STEMI patients treated with primary PCI, home warfarin therapy is associated with significant increase in the risk of in-hospital major bleeding despite the less frequent use of treatment regimens associated with higher bleeding risk. Future studies are needed to identify bleeding avoidance strategies in this high-risk population.
Details
- Title: Subtitle
- Abstract 78: The Association of Home Warfarin Therapy with Acute Treatment Patterns and Bleeding Risk in Patients Presenting with ST-Elevation Myocardial Infarction: Results from the NCDR
- Creators
- Wassef Karrowni - Roy J. and Lucille A. Carver College of MedicineTracy Y Wang - Duke UniversityAnita Y Chen - Duke UniversityLaine Thomas - Duke UniversityJorge F Saucedo - University of Oklahoma Health Sciences CenterRamzi N El Accaoui - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Circulation Cardiovascular quality and outcomes, Vol.6(suppl_1)
- DOI
- 10.1161/circoutcomes.6.suppl_1.A78
- ISSN
- 1941-7713
- eISSN
- 1941-7705
- Language
- English
- Date published
- 05/2013
- Academic Unit
- Radiology; Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984320091402771
Metrics
2 Record Views