Prophylactic warfarin post anterior ST-elevation myocardial infarction: A systematic review and meta-analysis

Autor: Jimmy MacHaalany, Olivier F. Bertrand, Stephen A. LaHaye, Nathaniel Moulson
Rok vydání: 2017
Předmět:
Male
medicine.medical_treatment
Embolism
030204 cardiovascular system & hematology
Cochrane Library
Ventricular Function
Left
0302 clinical medicine
Risk Factors
Odds Ratio
030212 general & internal medicine
Stroke
Aged
80 and over
Ejection fraction
General Medicine
Middle Aged
Treatment Outcome
Meta-analysis
Cardiology
Female
Cardiology and Cardiovascular Medicine
medicine.drug
Adult
medicine.medical_specialty
Adolescent
Hemorrhage
Young Adult
03 medical and health sciences
Percutaneous Coronary Intervention
Internal medicine
medicine
Humans
cardiovascular diseases
Anterior Wall Myocardial Infarction
Aged
Chi-Square Distribution
business.industry
Warfarin
Anticoagulants
Percutaneous coronary intervention
Stroke Volume
Thrombosis
Odds ratio
Left ventricular thrombus
medicine.disease
Myocardial Contraction
ST Elevation Myocardial Infarction
business
Platelet Aggregation Inhibitors
Zdroj: Cardiovascular Revascularization Medicine. 18:559-564
ISSN: 1553-8389
DOI: 10.1016/j.carrev.2017.05.002
Popis: Objectives 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. Background 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. Methods 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. Results 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]). Conclusions 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.
Databáze: OpenAIRE
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