title: Combined use of warfarin and oral P2Y12 inhibitors in patients with atrial fibrillation and acute coronary syndrome.
abstract: BACKGROUND
  Although atrial fibrillation (AF) occurs frequently in patients hospitalized with acute coronary syndrome (ACS), strategies for prevention of thromboembolic complications are poorly characterized.
  
  
  OBJECTIVE
  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.
authors: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: W Schuyler
authors: WS
authors: Jones
authors: Xiaojuan
authors: X
authors: Mi
authors: Manesh R
authors: MR
authors: Patel
authors: Roger
authors: R
authors: Mills
authors: Adrian F
authors: AF
authors: Hernandez
authors: Lesley H
authors: LH
authors: Curtis
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002481:Cellulitis / Q000453:epidemiology; D015897:Comorbidity; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D006801:Humans; D008297:Male; D006278:Medicare; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D015607:Stents; D013923:Thromboembolism / Q000517:prevention & control; D014481:United States; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D058921:Purinergic P2Y Receptor Antagonists; D014859:Warfarin