Patients with acute myocardial infarction (AMI) on warfarin or direct oral anticoagulants (DOACs) do not have an increased risk of in-hospital bleeding, compared with AMI patients not taking an anticoagulant, according to a study published April 16 in the Journal of the American Heart Association.

Dmitriy N. Feldman, MD, FACC, et al., used data from ACC's Chest Pain – MI Registry to examine in-hospital major bleeding based on home use of anticoagulants in 24,955 STEMI and NSTEMI patients with atrial fibrillation (AFib) or flutter. Among patients receiving home anticoagulants, the researchers also looked at the relationship between in-hospital outcomes and home anticoagulant status (warfarin vs. DOACs).

According to the results, among 6,471 STEMI patients with AFib or flutter, 15.7 percent were on warfarin, 13.0 percent were on DOACs and 71.3 percent were not taking an anticoagulant. Of 19,954 NSTEMI patients, 22.8 percent were on warfarin, 15.4 percent were on DOACs and 61.9 percent were not taking an anticoagulant.

Among STEMI patients, there were no significant differences in major bleeding based on anticoagulant status, with major bleeding occurring in 12.4 percent of those on warfarin, 11.2 percent on DOACs and 13.2 percent for no anticoagulant. In addition, among STEMI patients undergoing primary PCI or receiving thrombolytic therapy, there were no differences in major bleeding based on anticoagulant status. STEMI patients had in-hospital mortality rates of 14.7 percent for those on warfarin, 10.8 percent on DOACs and 14.9 percent not on an anticoagulant.

For NSTEMI patients, in-hospital major bleeding rates were 7.0 percent among those on warfarin, 5.7 percent on DOACs and 6.7 percent for no anticoagulant. NSTEMI patients who received angiography or PCI within 48 hours were more likely to experience bleeding than those treated conservatively. Among NSTEMI patients, the in-hospital mortality rates were 5.5 percent for those on warfarin, 3.7 percent for DOACs and 6.1 percent for no anticoagulant.

According to the researchers, the study suggests that home use of warfarin or DOACs is not associated with increased bleeding among AMI patients with a prior history of AFib and may be associated with reduced mortality risk compared with no anticoagulant. They conclude that "in-hospital outcomes of STEMI and NSTEMI patients with AFib are not negatively affected by home warfarin or DOAC therapy despite the perceived high bleeding risk."

Keywords: Warfarin, Anticoagulants, Atrial Fibrillation, Myocardial Infarction, Hemorrhage, Chest Pain, Chest Pain MI Registry, Registries, National Cardiovascular Data Registries, Thrombolytic Therapy, Angiography, Percutaneous Coronary Intervention

< Back to Listings