Frequency and Effects of Excess Dosing of Anticoagulants in Patients ≤55 Years of Age with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention (From the VIRGO Study) Aakriti Gupta, MD a,c , Philip Chui, MD b , Shengfan Zhou, MS a,c , John A. Spertus, MD MPH d,e , Mary Geda, MSN a , Nancy Lorenze, DNSc MSN a , Ike Lee a , Gail D’ Onofrio, MD MS f , Judith H. Lichtman, PhD MPH a,g , Karen P. Alexander, MD h , Harlan M. Krumholz, MD SM a,c,i,j , and Jeptha P. Curtis, MD a,c a Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Connecticut b Department of Internal Medicine, University of California, Irvine c Section of Cardiovascular Medicine, Yale University School of Medicine, Connecticut d Saint Luke's Mid America Heart Institute, Kansas City, Missouri e University of Missouri-Kansas City, Kansas City, Missouri f Department of Emergency Medicine, Yale University School of Medicine, Connecticut g Department of Chronic Disease Epidemiology, Yale School of Public Health, Connecticut h Duke University Medical Center, Duke Clinical Research Institute, North Carolina i Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, Connecticut j Department of Health Policy and Management, Yale School of Public Health, Connecticut Abstract 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 © 2015 Published by Elsevier Inc. Address for Correspondence: Dr. Jeptha Curtis, 1 Church Street, Suite 200, New Haven, Connecticut 06510; 203-764-5885, (f) 203-764-5653; jeptha.curtis@yale.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflict of Interest Statement: Dr. Curtis holds equity interest in Medtronic. HHS Public Access Author manuscript Am J Cardiol. Author manuscript; available in PMC 2016 July 01. Published in final edited form as: Am J Cardiol. 2015 July 1; 116(1): 1–7. doi:10.1016/j.amjcard.2015.03.032. Author Manuscript Author Manuscript Author Manuscript Author Manuscript