Incidence of early left ventricular thrombus after acute anterior wall myocardial infarction in the primary coronary intervention era

Osherov, Azriel B.; Borovik-Raz, Michal; Aronson, Doron; Agmon, Yoram; Kapeliovich, Michael; Kerner, Arthur; Grenadier, Ehud; Hammerman, Haim; Nikolsky, Eugenia; Roguin, Ariel

doi:10.1016/j.ahj.2009.03.020

Cited by 87 publications

(51 citation statements)

References 33 publications

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“…Clinical embolism occurred in only 1.6% of patients in our study, although no incidents were identifi ed in patients in the TT group. Th e low overall rates of clinical embolism and LVT found are consistent with other studies that have evaluated the clinical course after an acute anterior wall MI in the PCI era (3,5,11,13,15). Interestingly, our results also mirror similar results seen in chronic heart failure patients with signifi cant systolic dysfunction (16,17).…”

Section: Discussionsupporting

confidence: 90%

“…Th e reported incidence of LVT formation and subsequent embolization varies based on the timing of the echocardiographic examination and the diagnostic, anticoagulation, and reperfusion strategies utilized in managing the initial presentation but is noted to range from 0 to as high as 86% (1)(2)(3)(4)(5)(6)(7)(8)(9). Warfarin as a prophylactic strategy is therefore utilized and suggested in guidelines based on data derived from pooled results of studies done before catheter-based treatment of STEMI was prominent (10,11).…”

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confidence: 99%

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Dual Antiplatelet Compared to Triple Antithrombotic Therapy in Anterior Wall Acute Myocardial Infarction Complicated by Depressed Left Ventricular Ejection Fraction

Oyetayo

Slicker

Rosa³

et al. 2015

Baylor University Medical Center Proceedings

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Current guidelines recommend triple antithrombotic therapy (TT) consisting of warfarin, aspirin, and a P2Y12 inhibitor following an anterior ST elevation myocardial infarction (STEMI) complicated by extensive wall motion abnormalities. This recommendation, however, is based on data collected before percutaneous coronary intervention (PCI) became the standard of care for the treatment of STEMI. We designed a retrospective study of patients who received PCI for anterior STEMI over an 8-year period to compare rates of thromboembolic and bleeding events between patients receiving dual antiplatelet therapy (DAPT) and those receiving TT, including warfarin. Patients were included if the predischarge echocardiogram showed extensive wall motion abnormality and an ejection fraction ≤35%. Patients with known left ventricular thrombus were excluded. A total of 124 patients met the criteria, with 80 patients in the DAPT group and 44 in the TT group. The median age was 58 years in the TT group and 64 years in the DAPT group (P < 0.04), with an average ejection fraction of 31%. Thromboembolic events occurred in 4 patients (5%) in the DAPT group compared with 3 patients (6.8%) in the TT group (P = 0.70). Bleeding occurred in 2 patients in the DAPT group and 4 patients in the TT group (2.5% in DAPT vs. 9.1% in TT group, P = 0.18). No differences in rates of clinical embolism or left ventricular thrombus were found. Our data support recent findings that warfarin may not be indicated for patients following PCI for anterior STEMI, even when significant wall motion abnormalities and reduced ejection fraction ≤35% are present.A cute thromboembolic events due to left ventricular thrombus (LVT) formation, particularly in patients with reduced ejection fraction (EF), remain a risk for patients surviving an anterior ST elevation myocardial infarction (STEMI) (1). Th e reported incidence of LVT formation and subsequent embolization varies based on the timing of the echocardiographic examination and the diagnostic, anticoagulation, and reperfusion strategies utilized in managing the initial presentation but is noted to range from 0 to as high as 86% (1-9). Warfarin as a prophylactic strategy is therefore utilized and suggested in guidelines based on data derived from pooled results of studies done before catheter-based treatment of STEMI was prominent (10, 11). A recent report by Le May et al has suggested that warfarin treatment might be unnecessary in patients managed by primary PCI and dual antiplatelet therapy (DAPT) (12). Th e potential adequacy of DAPT alone was also shown in a small study that showed no advantage to a triple therapy (TT) regimen involving aspirin, a P2Y12 inhibitor, and warfarin when compared with DAPT with aspirin and a P2Y12 inhibitor in preventing LVT and systemic embolism (13). Given the uncertain benefi t and known bleeding risk associated with TT (14), we conducted a retrospective analysis spanning 8 years to compare the rates of LVT formation and thromboembolic events in patients with STEMI with EF ≤35% mana...

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Dual Antiplatelet Compared to Triple Antithrombotic Therapy in Anterior Wall Acute Myocardial Infarction Complicated by Depressed Left Ventricular Ejection Fraction

Oyetayo

Slicker

Rosa³

et al. 2015

Baylor University Medical Center Proceedings

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“…[453][454][455][456] More recent studies indicate that the incidence of mural thrombus is ≈15% in patients with anterior MI and 27% in those with anterior STEMI and an LV ejection fraction <40%. [457][458][459] In the absence of systemic anticoagulation, the risk of embolization within 3 months among patients with MI complicated by mural thrombus is 10% to 20%. 456,460 RCTs to assess the value of antithrombotic therapy for prevention of mural thrombus and stroke in patients with STEMI have not been conducted.…”

Section: Acute MI and Lv Thrombusmentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Kernan¹,

Ovbiagele²,

Black³

et al. 2014

Stroke

3,937

1,326

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The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

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“…241 Thrombolytic therapy may result in a lower incidence of LV thrombus formation, 242,244,245 but the magnitude of risk reduction is controversial. 246 The remainder of ventricular mural thrombi occur in patients with chronic ventricular dysfunction resulting from coronary disease, hypertension, or other forms of dilated cardiomyopathy, who face a persistent risk of stroke and systemic embolism whether or not AF is documented. Over the past 20 years, 3 large trials involving patients with acute inferior and anterior MIs concluded that initial treatment with heparin followed by administration of warfarin reduced the occurrence of cerebral embolism from 3% to 1% compared with no anticoagulation.…”

Section: B Acute MI and Lv Thrombusmentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack

Furie¹,

Kasner²,

Adams³

et al. 2011

Stroke

1,411

591

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Abstract-The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches to the implementation of guidelines and their use in high-risk populations. (Stroke. 2011;42:227-276.)

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Incidence of early left ventricular thrombus after acute anterior wall myocardial infarction in the primary coronary intervention era

Cited by 87 publications

References 33 publications

Dual Antiplatelet Compared to Triple Antithrombotic Therapy in Anterior Wall Acute Myocardial Infarction Complicated by Depressed Left Ventricular Ejection Fraction

Dual Antiplatelet Compared to Triple Antithrombotic Therapy in Anterior Wall Acute Myocardial Infarction Complicated by Depressed Left Ventricular Ejection Fraction

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack

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