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Interventional therapies and in-hospital outcomes in acute coronary syndromes complicated by von Willebrand disease.
Haemophilia 2017; 23(3):400-407H

Abstract

INTRODUCTION

von Willebrand disease (VWD) is one of the most common inherited bleeding disorders.

AIM

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.

RESULTS AND 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+Show Affiliations

Penn Comprehensive Hemophilia and Thrombosis Program, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA.Penn Comprehensive Hemophilia and Thrombosis Program, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27976460

Citation

Fogarty, P F., et al. "Interventional Therapies and In-hospital Outcomes in Acute Coronary Syndromes Complicated By Von Willebrand Disease." Haemophilia : the Official Journal of the World Federation of Hemophilia, vol. 23, no. 3, 2017, pp. 400-407.
Fogarty PF, Blair A, Vega R, et al. Interventional therapies and in-hospital outcomes in acute coronary syndromes complicated by von Willebrand disease. Haemophilia. 2017;23(3):400-407.
Fogarty, P. F., Blair, A., Vega, R., Matthai, W. H., & Gimotty, P. A. (2017). Interventional therapies and in-hospital outcomes in acute coronary syndromes complicated by von Willebrand disease. Haemophilia : the Official Journal of the World Federation of Hemophilia, 23(3), pp. 400-407. doi:10.1111/hae.13149.
Fogarty PF, et al. Interventional Therapies and In-hospital Outcomes in Acute Coronary Syndromes Complicated By Von Willebrand Disease. Haemophilia. 2017;23(3):400-407. PubMed PMID: 27976460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interventional therapies and in-hospital outcomes in acute coronary syndromes complicated by von Willebrand disease. AU - Fogarty,P F, AU - Blair,A, AU - Vega,R, AU - Matthai,W H, AU - Gimotty,P A, Y1 - 2016/12/14/ PY - 2016/11/09/accepted PY - 2016/12/16/pubmed PY - 2017/12/1/medline PY - 2016/12/16/entrez KW - acute coronary syndrome KW - cardiovascular disease KW - myocardial infarction KW - stent KW - von Willebrand disease SP - 400 EP - 407 JF - Haemophilia : the official journal of the World Federation of Hemophilia JO - Haemophilia VL - 23 IS - 3 N2 - INTRODUCTION: von Willebrand disease (VWD) is one of the most common inherited bleeding disorders. AIM: 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. RESULTS AND 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. SN - 1365-2516 UR - https://www.unboundmedicine.com/medline/citation/27976460/Interventional_therapies_and_in_hospital_outcomes_in_acute_coronary_syndromes_complicated_by_von_Willebrand_disease_ L2 - https://doi.org/10.1111/hae.13149 DB - PRIME DP - Unbound Medicine ER -