The American Journal of Medicine
Volume 123, Issue 2 , Pages 134-140, February 2010

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

  • Renato D. Lopes, MD, PhD

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • Corresponding Author InformationReprint requests should be addressed to Renato D. Lopes, MD, PhD, Duke University Medical Center Box 3850, Durham, NC 27710
    • ,
  • Aijing Starr

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Carl F. Pieper, DPH

      Affiliations

    • Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, NC
    • ,
  • Sana M. Al-Khatib, MD, MHS

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • L. Kristin Newby, MD, MHS

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Rajendra H. Mehta, MD, MS

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Frans Van de Werf, MD, PhD

      Affiliations

    • Department of Cardiology, University Hospital Gasthuisberg and Leuven Coordinating Center, Leuven, Belgium
    • ,
  • Kenneth W. Mahaffey, MD

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Paul W. Armstrong, MD

      Affiliations

    • Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Robert A. Harrington, MD

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
    • ,
  • Harvey D. White, DSc

      Affiliations

    • Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
    • ,
  • Lars Wallentin, MD

      Affiliations

    • Uppsala Clinical Research Center, Uppsala, Sweden
    • ,
  • Christopher B. Granger, MD

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC

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 (CHADS2) 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 CHADS2 score or bleeding risk.

Keywords: Acute coronary syndrome, Antithrombotics, Atrial fibrillation, Bleeding risk

 

 Funding: The Duke Clinical Research Institute.

 Conflict of Interest: The authors state that they have no conflict of interest regarding the content of the article.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(09)00876-6

doi:10.1016/j.amjmed.2009.09.015

The American Journal of Medicine
Volume 123, Issue 2 , Pages 134-140, February 2010

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