Abstract 5761: Anti-thrombotic and Anti-platelet Therapies for Acute Myocardial Infarction in Dialysis Patients: A Collaborative Project of the United States Renal Data System and National Registry of Myocardial Infarction
Background: Dialysis pts sustain high mortality rates from acute myocardial infarction (AMI) but were excluded from trials evaluating therapeutic strategies in AMI.
Aims: To compare the utilization of anti-thrombotic (AT) and anti-platelet (AP) therapies during AMI in dialysis vs. non-dialysis pts and the relation between outcomes of dialysis pts and the use of AT and AP therapies.
Methods: Retrospective cohort study using cross-matched data from the US Renal Data System database and 3rd National Registry of Myocardial Infarction for AMI hospitalizations between 04/01/1998 and 06/30/2000. A cohort of 3049 matching dialysis pts in both databases were identified; pts transferred in or out of the index hospital were excluded, leaving 2390 dialysis and 304096 non-dialysis pts for analysis.
Conclusions: AT and AP therapies are underutilized in dialysis pts with AMI. Aspirin use is associated with marked reduction in mortality and major cardiac events in both dialysis and non-dialysis pts. In contrast to non-dialysis patients, GP IIb/IIIa antagonist use is associated with a 3 fold increase in major bleeding in dialysis pts without any reduction in risk of cardiac events; and UF and LMW heparin use are also not associated with any reduction in mortality and cardiac events. Optimal AT and AP strategies in dialysis pts need to be further examined in prospective studies.