Document Detail


Atrial fibrillation and acute myocardial infarction: antithrombotic therapy and outcomes.
MedLine Citation:
PMID:  22795814     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Atrial fibrillation guidelines recommend long-term use of warfarin according to a patient's predicted risk of stroke. After acute myocardial infarction, however, combining warfarin and antiplatelet medications poses challenges.
METHODS: By using data from more than 69,255 patients with acute myocardial infarction who were enrolled in the National Cardiovascular Data Registry's Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines at 309 hospitals from July 1, 2008, to September 30, 2009, we describe the characteristics and outcomes of the population with myocardial infarction with atrial fibrillation diagnosed within 2 weeks before index myocardial infarction admission (7.1%, N=4947). Use of discharge antithrombotic therapy is described overall and across levels of predicted stroke and bleeding risks.
RESULTS: Compared with patients without atrial fibrillation, those with atrial fibrillation before their index myocardial infarction were older and had more comorbidities and worse in-hospital outcomes. Only 32.5% of patients with atrial fibrillation were taking warfarin before their myocardial infarction admission. In these patients, use of warfarin at discharge increased with higher Congestive heart failure, Hypertension, Age, Diabetes, Stroke [Doubled] (CHADS(2)) risk strata (28.5%, 34.6%, and 43.5% for CHADS(2) scores 0, 1, and ≥2; P<.001) and increased in patients at low, intermediate, and high risk of bleeding (25.4%, 42.3%, and 42.1%; P=.004). Triple therapy at discharge (aspirin plus clopidogrel plus warfarin) was used in a minority of this population (14.6%).
CONCLUSIONS: Use of warfarin at discharge in patients with atrial fibrillation is greater among those with higher stroke and bleeding risks, but despite higher-risk profiles, less than half received warfarin at discharge. These findings highlight that clarification is needed to guide choice of antithrombotic therapy for patients with both atrial fibrillation and acute myocardial infarction.
Authors:
Renato D Lopes; Li Li; Christopher B Granger; Tracy Y Wang; JoAnne M Foody; Marjorie Funk; Eric D Peterson; Karen P Alexander
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-07-13
Journal Detail:
Title:  The American journal of medicine     Volume:  125     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-03     Completed Date:  2012-11-02     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  897-905     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. renato.lopes@duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / adverse effects
Age Factors
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors / adverse effects
Anticoagulants / administration & dosage,  adverse effects*
Aspirin / adverse effects
Atrial Fibrillation / complications*,  drug therapy*
Comorbidity
Drug Therapy, Combination
Female
Fibrinolytic Agents / administration & dosage,  adverse effects*
Hemorrhage / chemically induced
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
Male
Middle Aged
Myocardial Infarction / complications*,  drug therapy*
Patient Discharge
Piperazines / adverse effects
Platelet Aggregation Inhibitors / administration & dosage,  adverse effects*
Research Design
Risk Assessment
Stroke / chemically induced
Thiophenes / adverse effects
Ticlopidine / adverse effects,  analogs & derivatives
Treatment Outcome
Warfarin / administration & dosage,  adverse effects*
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Anticoagulants; 0/Fibrinolytic Agents; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Piperazines; 0/Platelet Aggregation Inhibitors; 0/Thiophenes; 34K66TBT99/prasugrel; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 81-81-2/Warfarin; A74586SNO7/clopidogrel
Comments/Corrections
Comment In:
Am J Med. 2013 May;126(5):e21   [PMID:  23582944 ]
Am J Med. 2013 May;126(5):e19   [PMID:  23582943 ]

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