Document Detail

Use of anticoagulant agents and risk of bleeding among patients admitted with myocardial infarction: a report from the NCDR ACTION Registry--GWTG (National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry--Get With the Guidelines).
MedLine Citation:
PMID:  21087753     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to evaluate anticoagulant use patterns and bleeding risk in a contemporary population of patients with acute coronary syndrome.
BACKGROUND: Current practice guidelines support the use of unfractionated heparin, low molecular weight heparin, bivalirudin, or fondaparinux in non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Little is known about how these agents are selected in clinical practice.
METHODS: Between January 2007 and June 2009, data were captured for 72,699 patients with NSTEMI and 48,943 patients with STEMI at 360 U.S. hospitals for the NCDR ACTION Registry-GWTG (National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines). Patients were categorized based on anticoagulant strategy selected during hospitalization and their CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of ACC/AHA [American College of Cardiology/American Heart Association] Guidelines) bleeding risk category.
RESULTS: At least 1 anticoagulant was administered to 66,279 patients (91.2%) with NSTEMI and 46,149 patients (94.3%) with STEMI. Among STEMI patients, unfractionated heparin was most commonly used (66%), followed by bivalirudin (14%) and low molecular weight heparin (8%). In NSTEMI patients, unfractionated heparin was also the most commonly used anticoagulant (42%), followed by low molecular weight heparin (27%) and then bivalirudin (13%). There were significant differences in anticoagulant use by age, risk factors, concomitant medications, and invasive care. There was a 5-fold difference in the rate of bleeding between patients in the lowest and highest CRUSADE bleeding risk groups, which was consistently observed in most anticoagulant groups.
CONCLUSIONS: There is a wide variability in the use of anticoagulant regimens with significant differences according to baseline characteristics and concomitant therapies. Major bleeding is common, though a great degree of the variability in the rate of bleeding is largely based on differences in baseline characteristics, comorbidities, and invasive treatment strategies, rather than specific anticoagulant regimens.
Mitul B Kadakia; Nihar R Desai; Karen P Alexander; Anita Y Chen; Joanne M Foody; Christopher P Cannon; Stephen D Wiviott; Benjamin M Scirica;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  3     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-22     Completed Date:  2011-03-04     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1166-77     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Angioplasty, Balloon, Coronary
Anticoagulants / adverse effects*
Cardiac Catheterization
Chi-Square Distribution
Drug Utilization
Guideline Adherence
Hemorrhage / chemically induced*
Heparin / adverse effects
Heparin, Low-Molecular-Weight / adverse effects
Hirudins / adverse effects
Myocardial Infarction / drug therapy*
Outcome and Process Assessment (Health Care)* / statistics & numerical data
Peptide Fragments / adverse effects
Physician's Practice Patterns* / statistics & numerical data
Platelet Aggregation Inhibitors / therapeutic use
Practice Guidelines as Topic
Recombinant Proteins / adverse effects
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 0/Hirudins; 0/Peptide Fragments; 0/Platelet Aggregation Inhibitors; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin
Comment In:
JACC Cardiovasc Interv. 2010 Nov;3(11):1178-80   [PMID:  21087754 ]

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