Impact of home warfarin use on treatment patterns and bleeding complications for patients with non-ST-segment elevation acute coronary syndromes: observations from the CRUSADE quality improvement initiative.
OBJECTIVE
To examine treatment patterns and outcomes of patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) receiving long-term warfarin anticoagulation.


RESULTS
We examined acute medication and invasive cardiac procedure use and in-hospital outcomes among 101,078 patients with NSTE ACS included in the CRUSADE registry. On admission, 7201 patients (7%) were on home warfarin therapy. Compared with non-anticoagulated patients, these patients were older and had more comorbidities, but were less likely to receive acute antiplatelet and antithrombin medications. Patients on warfarin were also less likely to undergo coronary angiography (adjusted OR 0.77, 95% CI 0.70-0.86) and percutaneous coronary intervention (adjusted OR 0.80, 95% CI 0.75-0.86), and had longer waiting times for these procedures when performed. Although patients on warfarin had higher rates of death and major bleeding compared with non-anticoagulated patients, these differences were no longer significant after multivariable adjustment [ORs 0.90 (95% CI 0.80-1.02) and 1.02 (95% CI 0.93-1.11)]. Among patients on warfarin, however, early use of antiplatelet medications was associated with increased transfusion risk.


CONCLUSIONS
Despite higher-risk characteristics, warfarin-anticoagulated patients are often more conservatively managed, as early use of antithrombotic therapies may be associated with increased bleeding. Further investigation is needed to determine the optimal choice of therapies for this population.
Wang
Tracy Y
TY
Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Room 0311, Terrace Level, Durham, NC 27705, USA. wang0085@mc.duke.edu
Chen
Anita Y
AY
Peterson
Eric D
ED
Becker
Richard C
RC
Gibler
W Brian
WB
Ohman
E Magnus
EM
Roe
Matthew T
MT
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000601:surgery; D017677:Age Distribution; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D019317:Evidence-Based Medicine; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014859:Warfarin; D006493:Heparin