warfarin and Anterior-Wall-Myocardial-Infarction

To determine the role of warfarin (WF) prophylaxis in the prevention of left ventricular thrombus (LVT) formation and subsequent embolic complications following an anterior ST elevation myocardial infarction (STEMI) complicated by reduced left ventricular ejection fraction (LVEF) and wall motion abnormalities.. The role of oral anticoagulation prophylaxis, in addition to dual antiplatelet therapy (DAPT), in the current era of percutaneous coronary intervention has not been well studied, despite being a class IIb recommendation in the AHA/ACC STEMI guidelines.. The Cochrane search strategy was used to search PubMed, Embase and the Cochrane library for relevant results. Four studies, two retrospective, one prospective registry, and a randomized feasibility control trial met criteria for inclusion. Data was pooled using a random effects model and reported as odds ratios (OR) with their 95% confidence intervals (CI). Primary outcomes of interest were rate of stroke, major bleeding and mortality.. Pooled analysis included 526 patients in the No WF group and 347 patients in the WF group. No statistical difference in rate of stroke (OR: 2.72 [95% CI: 0.47-15.88; p=0.21]) or mortality (OR: 1.50 [95% CI 0.29-7.71; p=0.63]) was observed. Major bleeding was significantly higher in the WF group (OR: 2.56 [95% CI: 1.34-4.89; p=0.004]).. The routine use of DAPT and WF for prophylaxis against LVT formation following an anterior STEMI with associated decrease in LVEF and wall motion abnormalities, appears to result in no mortality benefit or reduction in stroke rates, but may increase the frequency of major bleeding.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anterior Wall Myocardial Infarction; Anticoagulants; Chi-Square Distribution; Embolism; Female; Hemorrhage; Humans; Male; Middle Aged; Myocardial Contraction; Odds Ratio; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Risk Factors; ST Elevation Myocardial Infarction; Stroke; Stroke Volume; Thrombosis; Treatment Outcome; Ventricular Function, Left; Warfarin; Young Adult

Left ventricular (LV) thrombus is one of the most common complications in patients with anterior acute myocardial infarction (AMI) and LV dysfunction. Although anticoagulation is frequently prescribed, data regarding the appropriate drug, duration, risks, and effect on echocardiographic indices of thrombus are lacking. Moreover, given the difficulty in obtaining adequate anticoagulation with warfarin, it is possible that short-term treatment with a more predictable agent would be effective. We randomized 60 patients at high risk of developing LV mural thrombus (anterior acute myocardial infarction with Q waves and ejection fraction≤40%) to receive either enoxaparin 1 mg/kg (maximum 100 mg) subcutaneously every 12 hours for 30 days or traditional anticoagulation (intravenous heparin followed by oral warfarin for 3 months). Clinical evaluations and transthoracic echocardiograms were obtained at baseline, in-hospital, and at 3.5 months. There were no differences between the groups regarding baseline demographics, acute echocardiographic findings, and in-hospital outcomes. The length of hospital stay tended to be shorter for the enoxaparin group (4.6 vs 5.6; p=0.066) and the corresponding hospital costs ($25,837 vs $34,666; p=0.18). At 3 months, bleeding and thromboembolic events were rare and similar between enoxaparin and warfarin groups. Although more patients had probable mural thrombus in the enoxaparin group compared with warfarin at 3.5 months (15% vs 4%; p=0.35), this was not significantly different. In conclusion, the use of enoxaparin tends to shorten hospitalization and lower cost of care. However, at 3.5 months, there appears to be numerically higher (but statistically insignificant) rates of LV thrombus in the enoxaparin group.

Topics: Adult; Aged; Aged, 80 and over; Anterior Wall Myocardial Infarction; Anticoagulants; Enoxaparin; Female; Heart Diseases; Heparin; Hospital Costs; Humans; Length of Stay; Male; Middle Aged; Percutaneous Coronary Intervention; Stroke Volume; Thrombosis; Treatment Outcome; Warfarin

To explore treatment with Direct Oral Anticoagulants (DOACs) in left ventricular thrombus (LVT) after ST-segment elevation myocardial infarction (STEMI) in patients who underwent percutaneous coronary intervention (PCI).. Contemporary data regarding using DOACs for LVT after STEMI patients who underwent PCI is limited.. To investigate the efficacy and safety of DOACs on the treatment of LVT post STEMI and PCI.. This retrospective study enrolled patients with LVT post STEMI and PCI within 1month from onset who received warfarin or DOACs at discharge. The primary endpoint was LVT resolution. Secondary endpoints were major adverse cardiovascular events (MACEs), including death, stroke, systemic embolism (SE), myocardial infarction (MI) and major or minor bleeding.. A total of 128 consecutive patients were recruited, of which 72 received warfarin and 56 DOACs [48 on rivaroxaban and 8 on dabigatran]. The rate of LVT resolution was higher within 1 month in the DOACs group than warfarin (26.8% vs. 11.1%; p = 0.022) (Kaplan-Meier estimates, p = 0.002). No significant differences were found at 3 months (p = 0.246), 6 months (p = 0.201), 9 months (p = 0.171) and 12 months (p = 0.442). No patients treated with DOACs had major bleeding, while two patients with warfarin had upper gastrointestinal bleeding (0 vs. 2 (2.8%); p = 0.209). No death or SE occurred. No significant differences on secondary endpoints were found in both the groups, including stroke, MI, minor bleeding and all bleeding events.. DOACs appear to be a suitable alternative to warfarin for the management of LVT post STEMI, especially in patients who are intolerant to warfarin.

Topics: Anterior Wall Myocardial Infarction; Anticoagulants; Hemorrhage; Humans; Myocardial Infarction; Percutaneous Coronary Intervention; Retrospective Studies; ST Elevation Myocardial Infarction; Stroke; Thrombosis; Treatment Outcome; Warfarin

The contemporary role of prophylactic anticoagulation following extensive anterior wall ST-segment myocardial infarction (STEMI) is unclear.. We evaluated anterior STEMI patients with left ventricle dysfunction (left ventricular ejection fraction ≤40%) ("high risk"), categorized by prophylactic warfarin use, within a regional STEMI. Patients with pre-existing atrial fibrillation were excluded. The primary outcome was an adjusted (for Global Registry of Acute Coronary Events risk score) 1-year composite of recurrent ischemia, stroke/transient ischemic attack/systemic embolism, or all-cause death. Of the 2032 STEMI admissions, 436 (21.5%) were high risk. After excluding 19 (4.4%) patients with definite left ventricle thrombus and 21 (4.8%) in-hospital deaths (2 had left ventricle thrombus), prophylactic warfarin was utilized in 236/398 (59.3%) high-risk survivors. Prescriptions were comparable across sex, but recipients were on average younger (58.5 years versus 64.0 years,. A high utilization of prophylactic warfarin occurs in anterior STEMI patients with left ventricle dysfunction, yet appears to provide no additional benefit on the ischemic composite. The association with lower all-cause mortality, but higher bleeding, calls for an improved understanding of its role in high-risk STEMI.

Topics: Administration, Oral; Aged; Alberta; Anterior Wall Myocardial Infarction; Anticoagulants; Chi-Square Distribution; Female; Hemorrhage; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Propensity Score; Registries; Risk Factors; ST Elevation Myocardial Infarction; Stroke; Stroke Volume; Thromboembolism; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left; Warfarin

Topics: Anterior Wall Myocardial Infarction; Anticoagulants; Aspirin; Drug Therapy, Combination; Humans; Infarction; Myocardial Infarction; Warfarin

Topics: Anterior Wall Myocardial Infarction; Anticoagulants; Female; Humans; Male; Percutaneous Coronary Intervention; Warfarin

This study sought to determine the benefits of adding oral anticoagulation therapy in patients with anterior wall ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI).. Guidelines suggest adding oral anticoagulation to dual-antiplatelet therapy in patients with STEMI when left ventricular apical akinesis or dyskinesis is present to prevent thromboembolic complications. The benefits of this triple therapy remain unknown.. We identified patients with anterior STEMI referred (PCI) between July 2004 and June 2010 with apical akinesis or dyskinesis on transthoracic echocardiography. We compared patients who were prescribed warfarin to patients who were not. We excluded patients with left ventricular thrombus, a separate need for oral anticoagulation, and previous intracranial bleeding. The primary outcome was a composite of net adverse clinical events (NACE) consisting of all-cause mortality, stroke, reinfarction, and major bleeding at 180 days.. Among 460 patients who qualified, 131 were discharged on warfarin therapy and 329 without warfarin therapy. Dual-antiplatelet therapy was prescribed for 99.2% of the patients in the warfarin group and for 97.6% of the patients in the no warfarin group (p = 0.46). Compared with patients in the no warfarin group, patients in the warfarin group had higher rates of NACE (14.7% vs. 4.6%, p = 0.001), death (5.4% vs. 1.5%, p = 0.04), stroke (3.1% vs. 0.3%, p = 0.02), and major bleeding (8.5% vs. 1.8%, p < 0.0001). By propensity score analysis, allocation to warfarin therapy was an independent predictor of NACE (odds ratio [OR]: 4.01, 95% confidence interval: 2.15 to 7.50, p < 0.0001). In a separate multivariable analysis, the OR of NACE remained significantly higher compared with patients who were not prescribed warfarin (OR: 3.13, 95% confidence interval: 1.34 to 7.22, p = 0.007).. Our results do not support the addition of warfarin therapy after primary PCI in patients with apical akinesis or dyskinesis.

Topics: Administration, Oral; Aged; Anterior Wall Myocardial Infarction; Anticoagulants; Drug Therapy, Combination; Female; Hemorrhage; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Propensity Score; Recurrence; Risk Factors; Stroke; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left; Warfarin

Topics: Anterior Wall Myocardial Infarction; Anticoagulants; Female; Humans; Male; Percutaneous Coronary Intervention; Warfarin

Topics: Anterior Wall Myocardial Infarction; Anticoagulants; Female; Humans; Male; Percutaneous Coronary Intervention; Warfarin

Patients with nephrotic syndrome are at risk of developing thrombosis in both veins and arteries. Various manifestations in different organs have been reported. Thrombi in heart seen, associated with multiorgan thrombosis have been reported on autopsy earlier, but only once in a living patient with nephrotic syndrome. Here, we report a 13 years old boy with steroid-resistant nephrotic syndrome, who developed an asymptomatic but potentially hazardous large intracardiac thrombus. The child developed nephrotic syndrome at the age of 9 years and had multiple recurrences. At the age of 13 years, he developed myocardial infarction (MI) due to embolism from a large intracardiac thrombus. Later on, he was treated with heparin and warfarin anticoagulation.

Topics: Acute Coronary Syndrome; Adolescent; Adrenal Cortex Hormones; Anterior Wall Myocardial Infarction; Anticoagulants; Coronary Angiography; Coronary Thrombosis; Disease Progression; Echocardiography, Doppler; Electrocardiography; Follow-Up Studies; Heparin; Humans; Male; Nephrotic Syndrome; Rare Diseases; Recurrence; Risk Assessment; Severity of Illness Index; Treatment Outcome; Warfarin

Topics: Aged; Anterior Wall Myocardial Infarction; Biopsy, Needle; Clopidogrel; Follow-Up Studies; Humans; Immunohistochemistry; Lupus Coagulation Inhibitor; Male; Platelet Aggregation Inhibitors; Polyarteritis Nodosa; Risk Assessment; Skin Diseases; Ticlopidine; Treatment Outcome; Warfarin