title: Warfarin use and outcomes in patients with atrial fibrillation complicating acute coronary syndromes.
abstract: BACKGROUND
  We examined warfarin use at discharge (according to Congestive heart failure, Hypertension, Age>75 years, Diabetes, Prior Stroke/transient ischemic attack score and bleeding risk) and its association with 6-month death or myocardial infarction in patients with post-acute coronary syndrome atrial fibrillation.
  
  
  METHODS
  Of the 23,208 patients enrolled in the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy, Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network A, and Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors trials, 4.0% (917 patients) had atrial fibrillation as an in-hospital complication and were discharged alive. Cox proportional hazards models were performed to assess 6-month outcomes after discharge.
  
  
  RESULTS
  Overall, 13.5% of patients with an acute coronary syndrome complicated by atrial fibrillation received warfarin at discharge. Warfarin use among patients with atrial fibrillation had no relation with estimated stroke risk; similar rates were observed across Congestive heart failure, Hypertension, Age>75 years, Diabetes, Prior Stroke/transient ischemic attack (CHADS(2)) scores (0, 13%; 1, 14%; > or = 2, 13%) and across different bleeding risk categories (low risk, 11.9%; intermediate risk, 13.3%; high risk, 11.1%). Among patients with in-hospital atrial fibrillation, warfarin use at discharge was independently associated with a lower risk of death or myocardial infarction within 6 months of discharge (hazard ratio 0.39; 95% confidence interval, 0.15-0.98).
  
  
  CONCLUSIONS
  Warfarin is associated with better 6-month outcomes among patients with atrial fibrillation complicating an acute coronary syndrome, but its use is not related to CHADS(2) score or bleeding risk.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Aijing
authors.initials: A
authors.lastname: Starr
authors.forename: Carl F
authors.initials: CF
authors.lastname: Pieper
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin