Document Detail


Warfarin use and outcomes in patients with atrial fibrillation complicating acute coronary syndromes.
MedLine Citation:
PMID:  20103022     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We examined warfarin use at discharge (according to Congestive heart failure, Hypertension, Age>75 years, Diabetes, Prior Stroke/transient ischemic attack score and bleeding risk) and its association with 6-month death or myocardial infarction in patients with post-acute coronary syndrome atrial fibrillation. METHODS: Of the 23,208 patients enrolled in the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy, Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network A, and Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors trials, 4.0% (917 patients) had atrial fibrillation as an in-hospital complication and were discharged alive. Cox proportional hazards models were performed to assess 6-month outcomes after discharge. RESULTS: Overall, 13.5% of patients with an acute coronary syndrome complicated by atrial fibrillation received warfarin at discharge. Warfarin use among patients with atrial fibrillation had no relation with estimated stroke risk; similar rates were observed across Congestive heart failure, Hypertension, Age>75 years, Diabetes, Prior Stroke/transient ischemic attack (CHADS(2)) scores (0, 13%; 1, 14%; > or = 2, 13%) and across different bleeding risk categories (low risk, 11.9%; intermediate risk, 13.3%; high risk, 11.1%). Among patients with in-hospital atrial fibrillation, warfarin use at discharge was independently associated with a lower risk of death or myocardial infarction within 6 months of discharge (hazard ratio 0.39; 95% confidence interval, 0.15-0.98). CONCLUSION: Warfarin is associated with better 6-month outcomes among patients with atrial fibrillation complicating an acute coronary syndrome, but its use is not related to CHADS(2) score or bleeding risk.
Authors:
Renato D Lopes; Aijing Starr; Carl F Pieper; Sana M Al-Khatib; L Kristin Newby; Rajendra H Mehta; Frans Van de Werf; Kenneth W Mahaffey; Paul W Armstrong; Robert A Harrington; Harvey D White; Lars Wallentin; Christopher B Granger
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  123     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-02-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  134-40     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 Elsevier Inc. All rights reserved.
Affiliation:
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / complications*,  mortality,  therapy*
Aged
Anticoagulants / therapeutic use*
Atrial Fibrillation / complications*,  mortality
Cohort Studies
Female
Fibrinolytic Agents
Hospitalization
Humans
Male
Middle Aged
Myocardial Infarction / epidemiology
Retrospective Studies
Treatment Outcome
Warfarin / therapeutic use*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 81-81-2/Warfarin

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