One-year clinical outcome of patients with left ventricular thrombus after acute myocardial infarction discharged on triple or dual antithrombotic therapy
| Autor: | Leonardo De Luca, Marco Pugliese, Lucia De Lio, Vito Piazza, Francesco Musumeci, Enrico Natale, Massimo Uguccioni, Elisa Bellettini, Rita Lucia Putini, Antonio Terranova, Elisabetta Biffani |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Myocardial Infarction law.invention Percutaneous Coronary Intervention Fibrinolytic Agents Randomized controlled trial law Internal medicine Antithrombotic medicine Humans Myocardial infarction Retrospective Studies Hematology business.industry Incidence (epidemiology) Anticoagulant Anticoagulants Thrombosis Left ventricular thrombus medicine.disease Patient Discharge Heart failure Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Thrombosis and Thrombolysis. 53:410-416 |
| ISSN: | 1573-742X 0929-5305 |
| Popis: | In patients with left ventricular thrombus (LVT) after acute myocardial infarction (MI), both anticoagulant and antiplatelet therapies are needed. It is unknown whether dual antithrombotic therapy (DAT) is able to reduce the incidence of bleeding complications without significantly increasing the number of thromboembolic events, compared to triple antithrombotic therapy (TAT). We retrospectively evaluated all post-MI patients with LVT discharged on TAT or DAT from our tertiary hospital in the last decade. The primary outcome was the occurrence of all-cause mortality, thromboembolic events, hospitalizations for re-MI or heart failure and any bleeding at 1 year. A propensity-score matching was performed in order to compare the primary outcome between TAT and DAT. Out of 2564 acute MI patients, 83 (3.2%) had an LVT at echocardiography: 51 (61.4%) discharged on TAT and 32 (38.6%) on DAT. At clinical follow-up, completed in 93% of cases, the incidence of the primary outcome was 18.2% (25.5% in TAT and 6.7% in DAT group; p = 0.04). More than 2/3 of the events included in the primary outcome were related to bleeding complications and occurred during the first month from hospital discharge. In the matched cohort of 42 patients with follow-up data available, the primary outcome occurred in 9 (42.9%) patients in the TAT and 2 (9.5%) in the DAT group (p = 0.03). In post-MI patients with LVT, DAT seems more effective than TAT in reducing clinical outcome, especially early bleeding complications. A randomized study is warranted to confirm this hypothesis. |
| Databáze: | OpenAIRE |
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