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    
Abstract/OtherAbstract:
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.
Authors:
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:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  127-32     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / adverse effects,  therapeutic use*
Aspirin / adverse effects,  therapeutic use*
Drug Therapy, Combination
Embolism / etiology
Feasibility Studies
Female
Hemorrhage / chemically induced
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / complications,  drug therapy,  mortality,  therapy*,  ultrasonography
Myocardial Revascularization* / adverse effects,  mortality
Ontario
Platelet Aggregation Inhibitors / adverse effects,  therapeutic use*
Recurrence
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*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Platelet Aggregation Inhibitors; 5Q7ZVV76EI/Warfarin; A74586SNO7/clopidogrel; OM90ZUW7M1/Ticlopidine; R16CO5Y76E/Aspirin

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