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Chronic VKA therapy and bleeding risk in STEMI patients

In ST elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI), chronic vitamin K antagonist (VKA) therapy increases in-hospital major bleeding risk significantly compared to no VKA therapy, irrespective of whether admission international normalised ratio (INR) was ≥2.0 or not, according to a study published recently in Heart.1

The authors also found that, in patients on VKA, glycoprotein IIb/IIIa inhibitors (GPI) was associated with increased bleeding risk, while bivalirudin was associated with decreased risk.

Acute management of STEMI patients on chronic VKA therapy is uncertain. This study aims to estimate in-hospital major bleeding risk among STEMI patients on chronic VKA treated with primary PCI; and determine the relationship between bleeding and acute treatments stratified by INR values.

The authors retrospectively examined 120,270 STEMI patients treated with primary PCI at 586 national registry hospitals (2007–2012). 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.

References

1. Karrowni W, Wang TY, Chen AY, Thomas L, Saucedo JF, El Accaoui Ramzi N. Chronic vitamin K antagonist therapy and bleeding risk in ST elevation myocardial infarction patients. Heart 2014. http://dx.doi.org/10.1136/heartjnl-2014-305931

Published on: October 31, 2014

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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