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Chronic vitamin K antagonist therapy and bleeding risk in ST elevation myocardial infarction patients.

Publication ,  Journal Article
Karrowni, W; Wang, TY; Chen, AY; Thomas, L; Saucedo, JF; El Accaoui, RN
Published in: Heart
February 2015

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.

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Published In

Heart

DOI

EISSN

1468-201X

Publication Date

February 2015

Volume

101

Issue

4

Start / End Page

264 / 270

Location

England

Related Subject Headings

  • Vitamin K
  • United States
  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Odds Ratio
 

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Karrowni, W., Wang, T. Y., Chen, A. Y., Thomas, L., Saucedo, J. F., & El Accaoui, R. N. (2015). Chronic vitamin K antagonist therapy and bleeding risk in ST elevation myocardial infarction patients. Heart, 101(4), 264–270. https://doi.org/10.1136/heartjnl-2014-305931
Karrowni, Wassef, Tracy Y. Wang, Anita Y. Chen, Laine Thomas, Jorge F. Saucedo, and Ramzi N. El Accaoui. “Chronic vitamin K antagonist therapy and bleeding risk in ST elevation myocardial infarction patients.Heart 101, no. 4 (February 2015): 264–70. https://doi.org/10.1136/heartjnl-2014-305931.
Karrowni W, Wang TY, Chen AY, Thomas L, Saucedo JF, El Accaoui RN. Chronic vitamin K antagonist therapy and bleeding risk in ST elevation myocardial infarction patients. Heart. 2015 Feb;101(4):264–70.
Karrowni, Wassef, et al. “Chronic vitamin K antagonist therapy and bleeding risk in ST elevation myocardial infarction patients.Heart, vol. 101, no. 4, Feb. 2015, pp. 264–70. Pubmed, doi:10.1136/heartjnl-2014-305931.
Karrowni W, Wang TY, Chen AY, Thomas L, Saucedo JF, El Accaoui RN. Chronic vitamin K antagonist therapy and bleeding risk in ST elevation myocardial infarction patients. Heart. 2015 Feb;101(4):264–270.

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

February 2015

Volume

101

Issue

4

Start / End Page

264 / 270

Location

England

Related Subject Headings

  • Vitamin K
  • United States
  • Treatment Outcome
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Odds Ratio