Combined use of warfarin and oral P2Y12 inhibitors in patients with atrial fibrillation and acute coronary syndrome.
Journal Article (Journal Article)
BACKGROUND: Although atrial fibrillation (AF) occurs frequently in patients hospitalized with acute coronary syndrome (ACS), strategies for prevention of thromboembolic complications are poorly characterized. HYPOTHESIS: We sought to examine exposure to warfarin and P2Y12 inhibitors and clinical outcomes among patients with AF and ACS. METHODS: Patients age >65 years hospitalized with a primary diagnosis of ACS and a secondary diagnosis of AF between 2007 and 2010 were identified in the Medicare 5% sample. Medication exposure was ascertained during a 90-day period following the index discharge using Medicare drug claims. Among patients who were alive and not readmitted during the ascertainment period, we examined the cumulative incidence of all-cause mortality and all-cause readmission by medication exposure at 1 year. RESULTS: A total of 2509 Medicare beneficiaries met the inclusion criteria. Among the 1633 patients (65%) who were alive and not readmitted during the 90-day ascertainment period, 24.0% received warfarin, 38.9% received P2Y12 inhibitors, 10.2% received combination therapy, and 26.8% received neither therapy. Readmission rates were high in all groups at 1 year (warfarin, 47.5%; P2Y12 inhibitors, 46.6%; combination therapy, 38.0%; and neither therapy, 39.3%), and the overall 1-year mortality rate was 12.5%. CONCLUSIONS: Among Medicare beneficiaries with AF and ACS, combination therapy with warfarin and P2Y12 inhibitor was uncommon during the 90-day ascertainment period, and more than one-quarter of patients had no claims for warfarin or P2Y12 inhibitors. Rates of all-cause readmission and mortality within 1 year of hospitalization for ACS were high.
Full Text
Duke Authors
Cited Authors
- Jones, WS; Mi, X; Patel, MR; Mills, R; Hernandez, AF; Curtis, LH
Published Date
- March 2014
Published In
Volume / Issue
- 37 / 3
Start / End Page
- 152 - 159
PubMed ID
- 24338960
Pubmed Central ID
- PMC6649619
Electronic International Standard Serial Number (EISSN)
- 1932-8737
Digital Object Identifier (DOI)
- 10.1002/clc.22231
Language
- eng
Conference Location
- United States