title: Interventional therapies and in-hospital outcomes in acute coronary syndromes complicated by von Willebrand disease.
abstract: BACKGROUND
  von Willebrand disease (VWD) is one of the most common inherited bleeding disorders.
  
  
  OBJECTIVE
  Investigate the impact of the VWD bleeding tendency on in-hospital management of acute coronary syndromes (ACS).
  
  
  METHODS
  Using discharge data from the National Inpatient Sample (NIS), the features of presentation and in-hospital treatment among ACS hospital discharges with and without a VWD diagnosis were investigated. A total of 264 case discharges and 705 860 control discharges were identified.
  
  
  CONCLUSIONS
  There was a significantly higher percentage of women among the case discharges compared to the control discharges (59.5% and 39.4%, respectively; P < 0.001). The rate of medical therapy alone [i.e. avoidance of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] was significantly higher among unstable angina cases than controls (55.0% vs. 46.4%; P = 0.01), and among cases undergoing PCI, bare-metal stents (BMS) were utilized in preference to drug-eluting stents (DES) (adjusted OR = 3.5); P < 0.001). No difference in in-hospital death was identified, but reported bleeding among discharges that underwent CABG was higher in cases compared to controls (12.9% vs. 5.2%; P = 0.047). Although medical and interventional management of ACS appears to be well tolerated in the majority of hospitalized patients with VWD, the gender ratio is reversed, interventions and DES are utilized less frequently and procedure-related bleeding may be increased, calling for further study.
authors.affiliation: Penn Comprehensive Hemophilia and Thrombosis Program, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: P F
authors.initials: PF
authors.lastname: Fogarty
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Blair
authors.affiliation: Penn Comprehensive Hemophilia and Thrombosis Program, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Vega
authors.affiliation: Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: Matthai
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Gimotty
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006470:Hemorrhage / Q000150:complications; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult; D014842:von Willebrand Diseases / Q000150:complications*
keywords: acute coronary syndrome; cardiovascular disease; myocardial infarction; stent; von Willebrand disease