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

Abstract

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.

Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction: A Multicenter, Randomized, Double-Blind Trial

“…[21][22][23] However, few randomized studies have evaluated the strategy of routine PPA in the contemporary era of drug-eluting stents and potent antiplatelet agents, although it is not uncommon in many countries. 5,8,[24][25][26][27][28][29] In contrast to PCI performed in more stable clinical conditions, the current European Society of Cardiology guidelines do not provide a clear recommendation for PPA after primary PCI for STEMI except when there is a separate indication for anticoagulation. 2 The American College of Cardiology Foundation/American Heart Association guidelines neither discuss nor give recommendations for PPA after primary PCI.…”

Risk stratification and anticoagulation strategies for post-PCI management in acute myocardial infarction patients with severe left ventricular dysfunction

“…The primary endpoint was confirmed echocardiographic LVT at 30 days. Secondary endpoints were 30-day mortality, embolic events, and significant hemorrhage incidents 17 . Kontny et al also investigated the prophylactic role of LMWH in AMI patients, treated with thrombolysis agents.…”