Outcomes Associated with Novel Oral Anticoagulants and Warfarin in Patients with Cardiac Thrombus Following STEMI.

Autor: Albaeni A; Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX, USA. Electronic address: aialbaen@utmb.edu., Li S; Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX, USA., Shan Y; Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX, USA., Thakker R; Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX, USA., Gaalema DE; Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX, USA., Mph RS; Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX, USA., Kuo YF; Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX, USA., Jneid H; Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX, USA., Goodwin J; Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX, USA.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2024 Nov 13. Date of Electronic Publication: 2024 Nov 13.
DOI: 10.1016/j.amjcard.2024.11.006
Abstrakt: The treatment of cardiac thrombus after ST-segment elevation myocardial infarction (STEMI) is anticoagulation. There is conflicting data on effectiveness and safety of novel oral anticoagulants (NOACs) vs. warfarin. Using the national Medicare data, we identified patients with an admission diagnosis of STEMI and cardiac thrombus within six months after STEMI. Patients were divided into two groups based on initial type of anticoagulation medication (NOACs vs. warfarin). The two main outcomes were ischemic stroke/transient ischemic attack (TIA) and bleeding. Follow-up was performed through the end of 2023. Kaplan-Meier (KM) Curves and Cox proportional hazard models were utilized. Of 881 patients prescribed anticoagulation after STEMI with subsequent cardiac thrombus, 496 patients were prescribed NOACs (56.3%) and 385 patients (43.7%) warfarin. For ischemic stroke, the median follow-up time was 177 days (95% CI: 148-193) for warfarin and 266 days (95% CI: 204-326) for NOACs. There was significantly lower risk of ischemic stroke or TIA in cardiac thrombus patients treated with NOACs compared to warfarin [HR 0.73 (0.57-0.93)]. For bleeding, the median follow-up time was 192 days (95% CI: 175-232) for warfarin and 277 days (95% CI: 212-332) for NOACs. There was also a lower risk of bleeding in patients treated with NOACs compared to warfarin [HR 0.78 (CI 0.66-0.92)]. In conclusion, STEMI patients with cardiac thrombus had lower risk of ischemic stroke and bleeding when treated with NOACs compared to warfarin. Prospective randomized studies are needed to confirm these findings and further examine the comparative effectiveness of different anticoagulant strategies.
Competing Interests: Declaration of competing interest Aiham Albaeni, Shuang Li, Yong Shan, Ravi Thakker, Diann E. Gaalema, Ritika Saxena, Yong-fang Kuo, Hani Jneid, and James Goodwin declare no conflict of interest.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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