PMID- 25336230
OWN - NLM
STAT- MEDLINE
DCOM- 20150527
LR  - 20150130
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 101
IP  - 4
DP  - 2015 Feb
TI  - Chronic vitamin K antagonist therapy and bleeding risk in ST elevation myocardial 
      infarction patients.
PG  - 264-70
LID - 10.1136/heartjnl-2014-305931 [doi]
AB  - 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.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not 
      already granted under a licence) please go to 
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Karrowni, Wassef
AU  - Karrowni W
AD  - UnityPoint Clinic-St Luke's Hospital, Cedar Rapids, Iowa, USA.
FAU - Wang, Tracy Y
AU  - Wang TY
AD  - Duke Clinical Research Institution, Duke University Medical Center, Durham, North 
      Carolina, USA.
FAU - Chen, Anita Y
AU  - Chen AY
AD  - Duke Clinical Research Institution, Duke University Medical Center, Durham, North 
      Carolina, USA.
FAU - Thomas, Laine
AU  - Thomas L
AD  - Duke Clinical Research Institution, Duke University Medical Center, Durham, North 
      Carolina, USA.
FAU - Saucedo, Jorge F
AU  - Saucedo JF
AD  - NorthShore University HealthSystem, Evanston, Illinois, USA.
FAU - El Accaoui, Ramzi N
AU  - El Accaoui RN
AD  - University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20141021
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 12001-79-5 (Vitamin K)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*adverse effects
MH  - Chi-Square Distribution
MH  - Female
MH  - Hemorrhage/blood/*chemically induced
MH  - Hospitalization
MH  - Humans
MH  - International Normalized Ratio
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Myocardial Infarction/blood/diagnosis/*therapy
MH  - Odds Ratio
MH  - *Percutaneous Coronary Intervention/adverse effects
MH  - Platelet Aggregation Inhibitors/adverse effects
MH  - Registries
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Treatment Outcome
MH  - United States
MH  - Vitamin K/*antagonists & inhibitors
EDAT- 2014/10/23 06:00
MHDA- 2015/05/28 06:00
CRDT- 2014/10/23 06:00
PHST- 2014/10/23 06:00 [entrez]
PHST- 2014/10/23 06:00 [pubmed]
PHST- 2015/05/28 06:00 [medline]
AID - heartjnl-2014-305931 [pii]
AID - 10.1136/heartjnl-2014-305931 [doi]
PST - ppublish
SO  - Heart. 2015 Feb;101(4):264-70. doi: 10.1136/heartjnl-2014-305931. Epub 2014 Oct 
      21.