Document Detail

Warfarin after anterior myocardial infarction in current era of dual antiplatelet therapy: a randomized feasibility trial.
MedLine Citation:
PMID:  20157843     Owner:  NLM     Status:  MEDLINE    
In the current era of early revascularization and routine use of dual antiplatelet therapy, the incremental benefit of warfarin to reduce the incidence of left ventricular thrombus (LVT) in patients with impaired left ventricular ejection fraction post anterior ST-elevation myocardial infarction (aSTEMI), remains uncertain. The purpose of this study is to assess the feasibility of evaluating the added benefit and safety of triple therapy (TT-warfarin, ASA, and clopidogrel) versus dual therapy (DT-ASA and clopidogrel) in patients at risk of LVT post aSTEMI. DESIGN: Open-label randomized controlled trial. INCLUSION: aSTEMI, ejection fraction <40%, and no evidence of LVT. EXCLUSION: contraindication to, or alternate indication for anticoagulation. INTERVENTION: TT versus DT. Follow-up: pre-discharge and 3 month echocardiogram. OUTCOMES: composite of death, MI, stroke, systemic embolizarion, LVT or major bleeding at three months. 295 patients with aSTEMI were screened: 27% of patients with LVEF < 40% had an LVT; 20/52 eligible patients were randomized to receive TT (n = 10) or DT (n = 10). Baseline characteristics: mean age 60 years, male gender 65%, diabetics 20%, and in hospital PCI 95%. There was no significant difference in the composite endpoint at 3 months (TT-20% with 1 LVT and 1 major bleed versus DT-10% with 1 MI). The incidence of definite or probable LVT in the screened population of patients post aSTEMI with an LVEF < 40% was 26.6% despite 94% having early revascularization. STEMI patients have a high incidence of LVT despite the routine use of early revascularization and dual antiplatelet therapy. More effective antithrombotic strategies merit evaluation in adequately powered randomized trials.
Jon-David R Schwalm; Mayraj Ahmad; Omid Salehian; John W Eikelboom; Madhu K Natarajan
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  30     ISSN:  1573-742X     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-26     Completed Date:  2010-11-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  127-32     Citation Subset:  IM    
Department of Medicine, Division of Cardiology, Hamilton Health Sciences and McMaster University, 5th Floor, McMaster Clinic, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.
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MeSH Terms
Anticoagulants / adverse effects,  therapeutic use*
Aspirin / adverse effects,  therapeutic use*
Drug Therapy, Combination
Embolism / etiology
Feasibility Studies
Hemorrhage / chemically induced
Middle Aged
Myocardial Infarction / complications,  drug therapy,  mortality,  therapy*,  ultrasonography
Myocardial Revascularization* / adverse effects,  mortality
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Stroke / etiology
Thrombosis / etiology,  mortality,  prevention & control*
Ticlopidine / adverse effects,  analogs & derivatives*,  therapeutic use
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left / etiology,  therapy
Warfarin / adverse effects,  therapeutic use*
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 81-81-2/Warfarin; 90055-48-4/clopidogrel

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