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. 2023 Sep 9;7(7):102198.
doi: 10.1016/j.rpth.2023.102198. eCollection 2023 Oct.

Acute myocardial infarction in von Willebrand disease: characteristics and outcomes

Orly Leiva  1 , Jean M Connors  2 , Nathan T Connell  2 , Jeffrey S Berger  1
Affiliations

Acute myocardial infarction in von Willebrand disease: characteristics and outcomes

Orly Leiva et al. Res Pract Thromb Haemost. .

Abstract

Background: 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.

Objective: To characterize outcomes of patients with VWD after AMI.

Methods: 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.

Results: 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%; P = 1.00), arterial thrombosis (1.9% vs 3.1%; P = .77), and bleeding (1.9% vs 0.4%; P = .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.

Conclusion: 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.

Keywords: acute myocardial infarction; bleeding; readmission; von Willebrand disease.

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Conflict of interest statement

J.C. reports scientific advisory board and consulting fees from Abbott, Anthos, Alnylam, Bristol Myers Squibb, Five Prime Therapeutics, and Pfizer, and research funding from CSL Behring. N.T.C. reports consulting from Takeda and Genentech and honoraria from Octapharma and Equity in Doximity. O.L. and J.S.B. have no competing interests to disclose.

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