Faculty Collaboration Database

Chronic vitamin K antagonist therapy and bleeding risk in ST elevation myocardial infarction patients. Heart 2015 Feb;101(4):264-70

Date

10/23/2014

Pubmed ID

25336230

DOI

10.1136/heartjnl-2014-305931

Scopus ID

2-s2.0-84921909467 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

OBJECTIVES: Acute management of ST elevation myocardial infarction (STEMI) patients on chronic vitamin K antagonist (VKA) therapy is uncertain. This study aims to estimate in-hospital major bleeding risk among STEMI patients on chronic VKA treated with primary percutaneous coronary intervention (PCI); and determine the relationship between bleeding and acute treatments stratified by international normalised ratio (INR) values.

METHODS: We retrospectively examined 120,270 STEMI patients treated with primary PCI at 586 national registry hospitals (2007-2012).

RESULTS: Overall, 3101 patients (2.6%) were on VKA which was associated with increased in-hospital major bleeding risk when compared with patients not on VKA (17.0%, vs 10.1%; adjusted OR 1.26, 95% CI 1.13 to 1.40). In patients on VKA, admission INR ≥2.0 was not associated with an increase in bleeding risk compared to INR <2.0. Patients on VKA were more likely to receive clopidogrel or bivalirudin within 24 h of presentation (acute), but less likely to receive prasugrel, heparin, or glycoprotein IIb/IIIa inhibitors (GPI). In those patients, acute GPI was associated with increased bleeding risk (adjusted OR 1.92, 95% CI 1.54 to 2.40) while bivalirudin was associated with decreased risk (adjusted OR 0.69, 95% CI 0.55 to 0.86); bleeding risk associated with heparin, bivalirudin, ADP-receptor blockers, or GPI was similar between INR ≥2.0 and <2.0.

CONCLUSIONS: In STEMI patients treated with primary PCI, chronic VKA therapy was associated with a significant increase in in-hospital major bleeding risk compared to no VKA therapy, irrespective of whether admission INR was ≥2.0 or not. In patients on VKA, GPI was associated with increased bleeding risk while bivalirudin was associated with decreased risk.

Author List

Karrowni W, Wang TY, Chen AY, Thomas L, Saucedo JF, El Accaoui RN

Author

Jorge Saucedo MD Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Anticoagulants
Chi-Square Distribution
Female
Hemorrhage
Hospitalization
Humans
International Normalized Ratio
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction
Odds Ratio
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Treatment Outcome
United States
Vitamin K