Frequency and Effects of Excess Dosing of Anticoagulants in Patients≤55 Years of Age with Acute Myocardial Infarction Undergoing Percutaneous CoronaryIntervention (From the VIRGO Study)

摘要

Excess dosing of anticoagulant agents has been linked to increased risk of bleeding after PCI for women as compared with men, but these studies have largely included older patients. We sought to determine the prevalence and sex-based differences of excess dosing of anticoagulants including glycoprotein inhibitors (GPIs), bivalirudin and unfractionated heparin (UFH), in young patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) and to examine its association with bleeding. Among 2076 patients enrolled in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study who underwent PCI, we abstracted doses of UFH, bivalirudin and GPIs administered during PCI from the medical records. At least 47.2% received at least one excess dose of an anticoagulant, which did not differ by sex. We used logistic regression to determine the predictors of excess dosing and the association of excess dosing with bleeding. In multivariable analysis, only lower body weight and younger age were significant predictors of excess dosing. Bleeding was higher in young women who received excess dosing versus those who did not (9.3% vs. 6.0%, P=0.03); but was comparable among men (5.2% vs. 5.9%, P=0.69) in univariate analysis. In multivariable analysis, there was a trend to an association between excess dosing and bleeding [OR, 1.33; 95% CI0.92–1.91]; although not statistically significant. In conclusion, approximatelyhalf of the patients received excess dosing of anticoagulant drugs during PCI, which didnot vary based upon sex. There was a trend towards an association between excess dosingand increased bleeding, although not statistically significant.