Comparison of the Usefulness of Enoxaparin Versus Warfarin for Prevention of Left Ventricular Mural Thrombus After Anterior Wall Acute Myocardial Infarction

White, Derek C.; Grines, Cindy L.; Grines, Lorelei; Marcovitz, Pamela A.; Messenger, John C.; Schreiber, Theodore

doi:10.1016/j.amjcard.2015.02.007

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…Patients were assigned to low‐molecular‐weight heparin (LMWH) for 30 days or to UFH bridge to warfarin with oral anticoagulation for 3 months. At 3 months, more patients in the LMWH group had probable thrombus (15% vs 4%), although the difference did not meet statistical significance . We did not collect information on the dosing of UFH used, and LMWH was used in <10% of patients in our study.…”

Section: Discussionmentioning

confidence: 87%

“…The use of clopidogrel as a single antiplatelet agent with warfarin after coronary stenting was compared with triple therapy, and although bleeding was reduced and no difference in ischemic outcomes was observed, the safety of this strategy is still debatable . A recent meta‐analysis from Gao et al reaffirms the risk of triple therapy and that alternative therapeutic regimens in PCI patients requiring oral anticoagulation may reduce bleeding without compromising safety …”

Section: Discussionmentioning

confidence: 99%

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Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST‐Segment Elevation Myocardial Infarction

Driesman

Hyder

Lang

et al. 2015

Clinical Cardiology

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Background The role of warfarin in anterior ST-segment elevation myocardial infarction (STEMI) complicated by left ventricular (LV) dysfunction in patients treated with primary percutaneous coronary intervention (PCI) and dual antiplatelet therapy (DAPT) is unclear. Warfarin may prevent cardioembolic events but significantly increases bleeding in the setting of DAPT. Hypothesis The incidence of LV thrombus in anterior STEMI patients treated with PCI is low and clinical predictors might be valuable in determining patents at risk. Methods We performed a retrospective, single center study of 687 consecutive patients with anterior STEMI treated with PCI from 2006 to 2013. Baseline variables were evaluated in 310 patients at high risk for LV thrombus based on echocardiographic criteria. Patients with definite, probable and no LV thrombus were compared by ANOVA, chi squared or T-test where appropriate. Logistic regression analysis was performed. Results The incidence of LV thrombus was 15% (n=47 probable/definite thrombus). Cardiac arrest was the only independent characteristic associated with increased risk of LV thrombus (OR 4.06, 1.3–12.7). Trends were observed for a lower risk in cardiogenic shock (OR 0.33, 0.10–1.05) and aspirin use at baseline (OR 0.43, 0.17–1.1). Treatment variables associated with LV thrombus included unfractionated heparin use post PCI (OR 2.43, 1.16–5.1), and use of balloon angioplasty without stent. Conclusions In contemporary practice with primary PCI, definite LV thrombus following anterior STEMI with LV dysfunction is challenging to predict. Further investigation is needed to determine if there is a subset of patients that should be treated with prophylactic warfarin.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST‐Segment Elevation Myocardial Infarction

Driesman

Hyder

Lang

et al. 2015

Clinical Cardiology

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“…Notably, the prevalence of LVT formation in our study was relatively low compared with that reported in the previous study. 2,14, 15 The underlying reason is unclear, but we suspect it may be that most patients in our study received timely primary PCI, DAPT and optimal heart failure treatment. More importantly, the incidence of major bleeding was not increased in the PPAC group.…”

Section: Study Limitationsmentioning

confidence: 92%

“…Another randomized trial chose warfarin as the control group and reported that enoxaparin for 30 days was associated with a numerically higher (not statistically significant) risk of LV thrombus compared with a 3-month course of warfarin. 15 However, the role of warfarin in preventing LVT remains controversial, which made it difficult to determine the precise contribution of PPAC to the prevention of LVT formation. In the present study, we compared patients who received PPAC (enoxaparin for 7 days after primary PCI) with those not receiving PPAC and found that the PPAC group had a significantly lower incidence of LVT.…”

Section: Study Limitationsmentioning

confidence: 99%

Post-Procedural Anticoagulation After Primary Percutaneous Coronary Intervention for Anterior Acute Myocardial Infarction With Severe Left Ventricular Dysfunction

Chen

Pei

et al. 2020

Circ J

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Background: Patients with anterior acute myocardial infarction (AMI) and left ventricular (LV) dysfunction have an increased risk of LV thrombus (LVT). In the thrombolytic era, short-term anticoagulation using low-molecular-weight heparin during hospitalization proved to significantly reduce LVT formation, but, the effect of this prophylactic approach remains unclear in the current era. Therefore, we conducted a study to evaluate the effects of post-procedural anticoagulation (PPAC) using enoxaparin in addition to dual antiplatelet therapy (DAPT) after primary percutaneous coronary intervention (PCI) in such patients. Methods and Results:A total of 426 anterior AMI patients with LV ejection fraction ≤40% were retrospectively enrolled and classified into 2 groups based on whether they received PPAC (enoxaparin SC for at least 7 days). All patients received primary PCI and DAPT. The primary endpoint was definite LVT at 30 days diagnosed by echocardiography. The secondary endpoints were 30-day mortality, embolic events, and major bleeding events. PPAC was independently associated with a lower incidence of LVT (odds ratio 0.139, 95% confidence interval 0.032−0.606, P=0.009). The 30-day mortality, embolic events, and major bleeding events were not statistically different between groups.Conclusions: Short-term PPAC using enoxaparin after primary PCI may be an effective and safe way to prevent LVT in patients with anterior AMI and LV dysfunction.

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“…Left ventricular thrombus (LVT) is a blood clot that forms in the left ventricle of heart due to stasis of blood. LVT leading to cerebrovascular accidents is a potentially catastrophic complication following anterior ST-segment elevation myocardial infarction (STEMI) [4]. Although anticoagulation is often prescribed for this, data regarding the appropriate drug, duration, risks, and effect on echocardiographic indices of thrombus are lacking.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Thrombus Formation in Acute Anterior Wall Myocardial Infarction: A Comparison Between Thrombolyzed and Non-Thrombolyzed Patients

Hashmi

Saeed

Ahmed

et al. 2020

Cureus

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Comparison of the Usefulness of Enoxaparin Versus Warfarin for Prevention of Left Ventricular Mural Thrombus After Anterior Wall Acute Myocardial Infarction

Cited by 9 publications

References 19 publications

Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST‐Segment Elevation Myocardial Infarction

Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST‐Segment Elevation Myocardial Infarction

Post-Procedural Anticoagulation After Primary Percutaneous Coronary Intervention for Anterior Acute Myocardial Infarction With Severe Left Ventricular Dysfunction

Left Ventricular Thrombus Formation in Acute Anterior Wall Myocardial Infarction: A Comparison Between Thrombolyzed and Non-Thrombolyzed Patients

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