Warfarin Use and Outcomes in Patients with Atrial Fibrillation Complicating Acute Coronary Syndromes

被引：38

作者：

Lopes, Renato D. ^{[1
]}

Starr, Aijing ^{[1
]}

Pieper, Carl F. ^{[2
]}

Al-Khatib, Sana M. ^{[1
]}

Newby, L. Kristin ^{[1
]}

Mehta, Rajendra H. ^{[1
]}

Van de Werf, Frans ^{[3
,4
]}

Mahaffey, Kenneth W. ^{[1
]}

Armstrong, Paul W. ^{[5
]}

Harrington, Robert A. ^{[1
]}

White, Harvey D. ^{[6
]}

Wallentin, Lars ^{[7
]}

Granger, Christopher B. ^{[1
]}

机构：

[1] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC 27710 USA

[2] Duke Univ, Sch Med, Dept Biostat & Bioinformat, Durham, NC 27710 USA

[3] Univ Hosp Gasthuisberg, Dept Cardiol, B-3000 Louvain, Belgium

[4] Leuven Coordinating Ctr, Louvain, Belgium

[5] Univ Alberta, Dept Med, Div Cardiol, Edmonton, AB, Canada

[6] Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand

[7] Uppsala Clin Res Ctr, Uppsala, Sweden

来源：

AMERICAN JOURNAL OF MEDICINE | 2010年 / 123卷 / 02期

关键词：

Acute coronary syndrome; Antithrombotics; Atrial fibrillation; Bleeding risk; ACUTE MYOCARDIAL-INFARCTION; ST-SEGMENT ELEVATION; HIGH-RISK PATIENTS; PROGNOSTIC-SIGNIFICANCE; ANTITHROMBOTIC THERAPY; TERM; SURVIVAL; STROKE;

D O I：

10.1016/j.amjmed.2009.09.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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%: >= 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. (C) 2010 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2010) 123, 134-140

引用

页码：134 / 140

页数：7

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