PMID- 15477397
OWN - NLM
STAT- MEDLINE
DCOM- 20050706
LR  - 20220317
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 110
IP  - 16
DP  - 2004 Oct 19
TI  - Impact of prior use or recent withdrawal of oral antiplatelet agents on acute 
      coronary syndromes.
PG  - 2361-7
AB  - BACKGROUND: Oral antiplatelet agents (OAAs) can prevent further vascular events 
      in cardiovascular disease. How prior use or recent discontinuation of OAA affects 
      clinical presentation of acute coronary syndromes (ACS) and clinical outcomes 
      (death, myocardial infarction [MI]) is unclear. METHODS AND RESULTS: We studied 
      and followed up for up to 30 days a cohort of 1358 consecutive patients admitted 
      for a suspected ACS; of these, 930 were nonusers, 355 were prior users of OAA, 
      and 73 had recently withdrawn OAA. Nonusers were at lower risk, more frequently 
      presented with ST-elevation MI on admission, and more frequently had Q-wave MI at 
      discharge than prior users (36.6% versus 17.5%, P<0.001; and 47.8% versus 28.2%, 
      P<0.001, respectively). However, there was no difference regarding the incidence 
      of death or MI at 30 days between nonusers and prior users (10.3% versus 12.4%, 
      P=NS). In addition, prior users experienced more major bleeds within 30 days 
      compared with nonusers (3.4% versus 1.4%, respectively; P=0.04). Recent 
      withdrawers were admitted on average 11.9+/-0.8 days after OAA withdrawal. 
      Interruption was primarily a physician decision for scheduled surgery (n=47 of 
      73). Despite a similar cardiovascular risk profile, recent withdrawers had higher 
      30-day rates of death or MI (21.9% versus 12.4%, P=0.04) and bleedings (13.7% 
      versus 5.9%, P=0.03) than prior users. After multivariate analysis, OAA 
      withdrawal was found to be an independent predictor of both mortality and 
      bleedings at 30 days. CONCLUSIONS: Among ACS patients, prior users represent a 
      higher-risk population and present more frequently with non-ST-elevation ACS than 
      nonusers. Although patients with a recent interruption of OAA resemble those 
      chronically treated by OAA, they display worse clinical outcomes.
FAU - Collet, J P
AU  - Collet JP
AD  - Institute of Cardiology, Pitie-Salpetriere Hospital, Paris, France.
FAU - Montalescot, G
AU  - Montalescot G
FAU - Blanchet, B
AU  - Blanchet B
FAU - Tanguy, M L
AU  - Tanguy ML
FAU - Golmard, J L
AU  - Golmard JL
FAU - Choussat, R
AU  - Choussat R
FAU - Beygui, F
AU  - Beygui F
FAU - Payot, L
AU  - Payot L
FAU - Vignolles, N
AU  - Vignolles N
FAU - Metzger, J P
AU  - Metzger JP
FAU - Thomas, D
AU  - Thomas D
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20041011
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Cardiovascular Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Acute Disease
MH  - Administration, Oral
MH  - Aged
MH  - Aspirin/administration & dosage/adverse effects/therapeutic use
MH  - Cardiovascular Agents/therapeutic use
MH  - Cohort Studies
MH  - Drug Therapy, Combination
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/epidemiology/etiology
MH  - Myocardial Ischemia/epidemiology/*etiology
MH  - Paris/epidemiology
MH  - Platelet Aggregation Inhibitors/administration & dosage/*adverse 
      effects/therapeutic use
MH  - Prospective Studies
MH  - Risk Factors
MH  - Syndrome
MH  - Thrombosis/prevention & control
MH  - Treatment Outcome
MH  - *Withholding Treatment
EDAT- 2004/10/13 09:00
MHDA- 2005/07/07 09:00
CRDT- 2004/10/13 09:00
PHST- 2004/10/13 09:00 [pubmed]
PHST- 2005/07/07 09:00 [medline]
PHST- 2004/10/13 09:00 [entrez]
AID - 01.CIR.0000145171.89690.B4 [pii]
AID - 10.1161/01.CIR.0000145171.89690.B4 [doi]
PST - ppublish
SO  - Circulation. 2004 Oct 19;110(16):2361-7. doi: 10.1161/01.CIR.0000145171.89690.B4. 
      Epub 2004 Oct 11.