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
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Article info
Footnotes
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.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
