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Outcomes among patients with non-ST-elevation myocardial infarction on chronic anticoagulation: Insights from the
Ahmed M Younes1, Ahmed Hashem2, Ahmed Maraey3
1Department of Internal Medicine, Riverside Shore Memorial Hospital, Onancock, Virginia, USA.
Insights
Chronic anticoagulation in non-ST-elevation myocardial infarction (NSTEMI) patients is linked to reduced mortality and healthcare costs. This study found no increase in major bleeding events, suggesting a favorable risk-benefit profile.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Chronic systemic anticoagulation is common for thromboembolic disorders.
- Anticoagulation is a standard initial treatment for non-ST-elevation myocardial infarction (NSTEMI).
Purpose of the Study:
- To investigate the in-hospital outcomes of NSTEMI patients already on chronic anticoagulation.
- To assess the impact of pre-existing anticoagulation on mortality, bleeding, and interventions in NSTEMI patients.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2016-2020.
- Identified NSTEMI patients and those on chronic anticoagulation using ICD-10 codes.
- Analyzed in-hospital mortality, major bleeding, ischemic CVA, PCI, CABG, length of stay (LOS), and total charges using multivariate regression.
Main Results:
- Chronic anticoagulation was associated with significantly lower in-hospital mortality (aOR: 0.69).
- No significant difference was observed in major bleeding or ischemic CVA rates.
- Patients on chronic anticoagulation had lower rates of early PCI and CABG, shorter LOS, and reduced total charges.
Conclusions:
- Chronic anticoagulation in NSTEMI patients correlates with decreased in-hospital mortality, LOS, and costs.
- The findings indicate no increased risk of major bleeding with pre-existing anticoagulation in this cohort.
Background:
Chronic systemic anticoagulation use is prevalent for various thromboembolic conditions. Anticoagulation (usually through heparin products) is also recommended for the initial management of non-ST-elevation myocardial infarction (NSTEMI).
Aims:
To evaluate the in-hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation.
Methods:
Using the National Inpatient Sample (NIS) years 2016-2020, NSTEMI patients and patients with chronic anticoagulation were identified using the appropriate International Classification of Diseases, 10th version (ICD-10) appropriate codes. The primary outcome was all-cause in-hospital mortality while the secondary outcomes included major bleeding, ischemic cerebrovascular accident (CVA), early percutaneous coronary intervention (PCI) (i.e., within 24 h of admission), coronary artery bypass graft (CABG) during hospitalization, length of stay (LOS), and total charges. Multivariate logistic or linear regression analyses were performed after adjusting for patient-level and hospital-level factors.
Results:
Among 2,251,914 adult patients with NSTEMI, 190,540 (8.5%) were on chronic anticoagulation. Chronic anticoagulation use was associated with a lower incidence of in-hospital mortality (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [CI]: 0.65-0.73, p < 0.001). There was no significant difference in major bleeding (aOR: 0.95, 95% CI: 0.88-1.0, p = 0.15) or ischemic CVA (aOR: 0.23, 95% CI: 0.03-1.69, p = 0.15). Chronic anticoagulation use was associated with a lower incidence of early PCI (aOR: 0.78, 95% CI: 0.76-0.80, p < 0.001) and CABG (aOR: 0.43, 95% CI: 0.41-0.45, p < 0.001). Chronic anticoagulation was also associated with decreased LOS and total charges (adjusted mean difference [aMD]: -0.8 days, 95% CI: -0.86 to -0.75, p < 0.001) and (aMD: $-19,340, 95% CI: -20,692 to -17,988, p < 0.001).
Conclusions:
Among patients admitted with NSTEMI, chronic anticoagulation use was associated with lower in-hospital mortality, LOS, and total charges, with no difference in the incidence of major bleeding.
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