Leiva Orly, Connors Jean M, Connell Nathan T, Berger Jeffrey S
Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Res Pract Thromb Haemost. 2023 Sep 9;7(7):102198. doi: 10.1016/j.rpth.2023.102198. eCollection 2023 Oct.
Von Willebrand disease (VWD) is the most common inherited bleeding disorder. As treatments have improved prognosis of VWD, age-related diseases, including acute myocardial infarction (AMI), have become more prevalent. The treatment of AMI includes antithrombotic therapies, which increase the risk of bleeding. Current guidelines suggest weighing risks/benefits of antithrombotic therapy in patients with VWD. However, data to inform these discussions are lacking.
To characterize outcomes of patients with VWD after AMI.
We conducted a retrospective cohort study utilizing the National Readmissions Database of patients with and without VWD admitted with AMI in 2017 and 2018. Primary outcomes were 90-day any-cause, bleeding-related, and arterial thrombosis-related readmissions. Case-control matching was performed for age, sex (male or female), ST-elevation myocardial infarction, percutaneous coronary intervention, diabetes, and chronic kidney disease. Time-to-event analysis was performed after matching using Cox proportional hazards regression.
A total of 136 patients with VWD were matched with 3400 controls without VWD. At 90 days, there were no differences in all-cause (10.7% vs 11.5%; = 1.00), arterial thrombosis (1.9% vs 3.1%; = .77), and bleeding (1.9% vs 0.4%; = .083) readmission in patients with VWD. VWD was associated with increased risk of 90-day bleeding (hazard ratio [HR], 4.75; 95% CI, 1.05-21.66) but not all-cause (HR, 0.91; 95% CI, 0.50-1.67) or arterial thrombosis (HR, 0.54; 95% CI, 0.39-2.19) readmission.
Among patients admitted with AMI, VWD was associated with higher risk of 90-day readmission for bleeding but not any-cause and arterial thrombosis-related readmissions. Further studies are needed to balance bleeding and thrombotic risks post-AMI in patients with VWD.
血管性血友病（VWD）是最常见的遗传性出血性疾病。随着治疗方法改善了VWD的预后，包括急性心肌梗死（AMI）在内的与年龄相关的疾病变得更加普遍。AMI的治疗包括抗栓治疗，这会增加出血风险。当前指南建议权衡VWD患者抗栓治疗的风险/益处。然而，缺乏用于这些讨论的数据。
描述AMI后VWD患者的结局。
我们利用2017年和2018年因AMI入院的有和没有VWD的患者的国家再入院数据库进行了一项回顾性队列研究。主要结局是90天内任何原因导致的、与出血相关的和与动脉血栓形成相关的再入院。对年龄、性别（男性或女性）、ST段抬高型心肌梗死、经皮冠状动脉介入治疗、糖尿病和慢性肾脏病进行病例对照匹配。匹配后使用Cox比例风险回归进行事件发生时间分析。
总共136例VWD患者与3,400例无VWD患者进行了匹配。在90天时，VWD患者的全因（10.7%对11.5%；P = 1.00）、动脉血栓形成（1.9%对3.1%；P = 0.77）和出血（1.9%对0.4%；P = 0.083）再入院率没有差异。VWD与90天出血风险增加相关（风险比[HR]，4.75；95%可信区间，1.05 - 21.66），但与全因（HR，0.91；95%可信区间，0.50 - 1.6）或动脉血栓形成（HR，0.54；95%可信区间，0.39 - 2.19）再入院无关。
在因AMI入院的患者中，VWD与90天出血再入院风险较高相关，但与任何原因及动脉血栓形成相关的再入院无关。需要进一步研究以平衡VWD患者AMI后的出血和血栓形成风险。
