Warfarin use and outcomes in patients with atrial fibrillation complicating acute coronary syndromes.

Abstract

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
• Journal: The American journal of medicine (Am J Med) Vol. 123 Issue 2 Pg. 134-40 (Feb 2010) ISSN: 1555-7162 [Electronic] United States
• PMID: 20103022 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright (c) 2010 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Fibrinolytic Agents
• Warfarin

Topics

• 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)