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The association between prior use of aspirin and/or warfarin and the in-hospital management and outcomes in patients presenting with acute coronary syndromes: insights from the Global Registry of Acute Coronary Events (GRACE).
Can J Cardiol. 2012 Jan-Feb; 28(1):48-53.CJ

Abstract

BACKGROUND

The role of acetylsalicylic acid (ASA [aspirin]) and warfarin in secondary prevention after acute coronary syndromes (ACS) is well established. However, there are sparse data comparing the presentation and outcomes of patients who present with ACS while on ASA and/or warfarin therapy and those on neither.

METHODS

Using data from the Canadian Global Registry of Acute Coronary Events (GRACE), we stratified 14,090 ACS patients into 4 groups according to prior use of antithrombotic therapies and compared in-hospital management and outcomes.

RESULTS

Among 14,090 ACS patients, 7411 (52.6%) were not on prior ASA or warfarin therapy, 5724 (40.6%) were on ASA only, 593 (4.2%) were on warfarin only, and 362 (2.6%) were on both ASA and warfarin. ACS patients taking ASA and/or warfarin were older with more comorbidities than the patients on neither drug. Patients receiving prior warfarin only or ASA and warfarin were less likely to receive guideline-recommended therapies. Patients who were taking prior warfarin only had higher unadjusted rates of death, death and/or reinfarction (re-MI), congestive heart failure (CHF), and major bleeding as compared with patients on no prior therapy. Furthermore, patients who were taking ASA and warfarin had higher unadjusted rates of death and/or re-MI and CHF than patients on prior ASA only.

CONCLUSIONS

ACS patients on prior warfarin are a high-risk population, yet they receive less guideline-recommended therapies and have higher unadjusted adverse event rates during their index hospitalization. With the increasing use of oral anticoagulants, clinical trials are needed to guide the optimal management of these ACS patients.

Authors+Show Affiliations

Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22112683

Citation

Amad, Hani, et al. "The Association Between Prior Use of Aspirin And/or Warfarin and the In-hospital Management and Outcomes in Patients Presenting With Acute Coronary Syndromes: Insights From the Global Registry of Acute Coronary Events (GRACE)." The Canadian Journal of Cardiology, vol. 28, no. 1, 2012, pp. 48-53.
Amad H, Yan AT, Yan RT, et al. The association between prior use of aspirin and/or warfarin and the in-hospital management and outcomes in patients presenting with acute coronary syndromes: insights from the Global Registry of Acute Coronary Events (GRACE). Can J Cardiol. 2012;28(1):48-53.
Amad, H., Yan, A. T., Yan, R. T., Huynh, T., Gore, J. M., Montalescot, G., DeYoung, J. P., Gallo, R., Rose, B., Steg, P. G., & Goodman, S. G. (2012). The association between prior use of aspirin and/or warfarin and the in-hospital management and outcomes in patients presenting with acute coronary syndromes: insights from the Global Registry of Acute Coronary Events (GRACE). The Canadian Journal of Cardiology, 28(1), 48-53. https://doi.org/10.1016/j.cjca.2011.09.003
Amad H, et al. The Association Between Prior Use of Aspirin And/or Warfarin and the In-hospital Management and Outcomes in Patients Presenting With Acute Coronary Syndromes: Insights From the Global Registry of Acute Coronary Events (GRACE). Can J Cardiol. 2012 Jan-Feb;28(1):48-53. PubMed PMID: 22112683.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between prior use of aspirin and/or warfarin and the in-hospital management and outcomes in patients presenting with acute coronary syndromes: insights from the Global Registry of Acute Coronary Events (GRACE). AU - Amad,Hani, AU - Yan,Andrew T, AU - Yan,Raymond T, AU - Huynh,Thao, AU - Gore,Joel M, AU - Montalescot,Gilles, AU - DeYoung,J Paul, AU - Gallo,Richard, AU - Rose,Barry, AU - Steg,P Gabriel, AU - Goodman,Shaun G, AU - ,, Y1 - 2011/11/23/ PY - 2011/06/24/received PY - 2011/09/01/revised PY - 2011/09/02/accepted PY - 2011/11/25/entrez PY - 2011/11/25/pubmed PY - 2012/3/21/medline SP - 48 EP - 53 JF - The Canadian journal of cardiology JO - Can J Cardiol VL - 28 IS - 1 N2 - BACKGROUND: The role of acetylsalicylic acid (ASA [aspirin]) and warfarin in secondary prevention after acute coronary syndromes (ACS) is well established. However, there are sparse data comparing the presentation and outcomes of patients who present with ACS while on ASA and/or warfarin therapy and those on neither. METHODS: Using data from the Canadian Global Registry of Acute Coronary Events (GRACE), we stratified 14,090 ACS patients into 4 groups according to prior use of antithrombotic therapies and compared in-hospital management and outcomes. RESULTS: Among 14,090 ACS patients, 7411 (52.6%) were not on prior ASA or warfarin therapy, 5724 (40.6%) were on ASA only, 593 (4.2%) were on warfarin only, and 362 (2.6%) were on both ASA and warfarin. ACS patients taking ASA and/or warfarin were older with more comorbidities than the patients on neither drug. Patients receiving prior warfarin only or ASA and warfarin were less likely to receive guideline-recommended therapies. Patients who were taking prior warfarin only had higher unadjusted rates of death, death and/or reinfarction (re-MI), congestive heart failure (CHF), and major bleeding as compared with patients on no prior therapy. Furthermore, patients who were taking ASA and warfarin had higher unadjusted rates of death and/or re-MI and CHF than patients on prior ASA only. CONCLUSIONS: ACS patients on prior warfarin are a high-risk population, yet they receive less guideline-recommended therapies and have higher unadjusted adverse event rates during their index hospitalization. With the increasing use of oral anticoagulants, clinical trials are needed to guide the optimal management of these ACS patients. SN - 1916-7075 UR - https://www.unboundmedicine.com/medline/citation/22112683/The_association_between_prior_use_of_aspirin_and/or_warfarin_and_the_in_hospital_management_and_outcomes_in_patients_presenting_with_acute_coronary_syndromes:_insights_from_the_Global_Registry_of_Acute_Coronary_Events__GRACE__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0828-282X(11)01247-5 DB - PRIME DP - Unbound Medicine ER -