Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction
Abstract Aims There are limited data about the optimal anti-thrombotic therapy for preventing embolism while minimizing bleeding events in patients with first acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT). Methods and results Among 2301 consecutive patients with AM...
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| Veröffentlicht in: | European heart journal 2018-01, Vol.39 (3), p.201-208 |
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| creator | Maniwa, Naoki Fujino, Masashi Nakai, Michikazu Nishimura, Kunihiro Miyamoto, Yoshihiro Kataoka, Yu Asaumi, Yasuhide Tahara, Yoshio Nakanishi, Michio Anzai, Toshihisa Kusano, Kengo Akasaka, Takashi Goto, Yoichi Noguchi, Teruo Yasuda, Satoshi |
| description | Abstract
Aims
There are limited data about the optimal anti-thrombotic therapy for preventing embolism while minimizing bleeding events in patients with first acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT).
Methods and results
Among 2301 consecutive patients with AMI hospitalized between 2001 and 2014, we studied 1850 patients with first AMI who discharged alive to investigate clinical characteristics, incidence of systemic embolism (SE), and association between anticoagulation and embolic or bleeding events. Left ventricular thrombus was diagnosed by echocardiography, left ventriculography, or cardiac magnetic resonance imaging in 92 (5.0%) patients (62 ± 12 years). During a median follow-up period of 5.4 years (interquartile range 2.1–9.1 years), SE occurred in 15 of 92 patients with LVT (16.3%) and 51 of 1758 patients without LVT (2.9%), respectively. Kaplan–Meier analysis showed a significantly higher incidence of SE in the LVT group (log-rank test, P |
| doi_str_mv | 10.1093/eurheartj/ehx551 |
| format | Article |
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Aims
There are limited data about the optimal anti-thrombotic therapy for preventing embolism while minimizing bleeding events in patients with first acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT).
Methods and results
Among 2301 consecutive patients with AMI hospitalized between 2001 and 2014, we studied 1850 patients with first AMI who discharged alive to investigate clinical characteristics, incidence of systemic embolism (SE), and association between anticoagulation and embolic or bleeding events. Left ventricular thrombus was diagnosed by echocardiography, left ventriculography, or cardiac magnetic resonance imaging in 92 (5.0%) patients (62 ± 12 years). During a median follow-up period of 5.4 years (interquartile range 2.1–9.1 years), SE occurred in 15 of 92 patients with LVT (16.3%) and 51 of 1758 patients without LVT (2.9%), respectively. Kaplan–Meier analysis showed a significantly higher incidence of SE in the LVT group (log-rank test, P < 0.001). Multivariate analysis showed that LVT was an independent predictor of SE. Among the LVT patients treated with vitamin K antagonists (n = 84), we compared the patients with therapeutic range (TTR) ≥50% (n = 34) and those with TTR <50% (n = 50). Only one embolic event developed in the TTR ≥50% group and nine embolic events developed in the TTR <50% group (2.9% vs. 19%, P = 0.036). There was no difference in major bleeding events (TTR ≥50%; 9% vs. TTR <50%; 8%, P = 0.89).
Conclusion
Appropriate anticoagulation therapy may decrease the incidence of embolic events without increasing the incidence of bleeding events in patients with first AMI complicated by LV thrombus.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehx551</identifier><identifier>PMID: 29029233</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>European heart journal, 2018-01, Vol.39 (3), p.201-208</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com. 2017</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c377t-a2e0876c7a337a8cf9cdef10a623c3ae0192f4bd395892b54cb0eda7a2cb9a643</citedby><cites>FETCH-LOGICAL-c377t-a2e0876c7a337a8cf9cdef10a623c3ae0192f4bd395892b54cb0eda7a2cb9a643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29029233$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maniwa, Naoki</creatorcontrib><creatorcontrib>Fujino, Masashi</creatorcontrib><creatorcontrib>Nakai, Michikazu</creatorcontrib><creatorcontrib>Nishimura, Kunihiro</creatorcontrib><creatorcontrib>Miyamoto, Yoshihiro</creatorcontrib><creatorcontrib>Kataoka, Yu</creatorcontrib><creatorcontrib>Asaumi, Yasuhide</creatorcontrib><creatorcontrib>Tahara, Yoshio</creatorcontrib><creatorcontrib>Nakanishi, Michio</creatorcontrib><creatorcontrib>Anzai, Toshihisa</creatorcontrib><creatorcontrib>Kusano, Kengo</creatorcontrib><creatorcontrib>Akasaka, Takashi</creatorcontrib><creatorcontrib>Goto, Yoichi</creatorcontrib><creatorcontrib>Noguchi, Teruo</creatorcontrib><creatorcontrib>Yasuda, Satoshi</creatorcontrib><title>Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Abstract
Aims
There are limited data about the optimal anti-thrombotic therapy for preventing embolism while minimizing bleeding events in patients with first acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT).
Methods and results
Among 2301 consecutive patients with AMI hospitalized between 2001 and 2014, we studied 1850 patients with first AMI who discharged alive to investigate clinical characteristics, incidence of systemic embolism (SE), and association between anticoagulation and embolic or bleeding events. Left ventricular thrombus was diagnosed by echocardiography, left ventriculography, or cardiac magnetic resonance imaging in 92 (5.0%) patients (62 ± 12 years). During a median follow-up period of 5.4 years (interquartile range 2.1–9.1 years), SE occurred in 15 of 92 patients with LVT (16.3%) and 51 of 1758 patients without LVT (2.9%), respectively. Kaplan–Meier analysis showed a significantly higher incidence of SE in the LVT group (log-rank test, P < 0.001). Multivariate analysis showed that LVT was an independent predictor of SE. Among the LVT patients treated with vitamin K antagonists (n = 84), we compared the patients with therapeutic range (TTR) ≥50% (n = 34) and those with TTR <50% (n = 50). Only one embolic event developed in the TTR ≥50% group and nine embolic events developed in the TTR <50% group (2.9% vs. 19%, P = 0.036). There was no difference in major bleeding events (TTR ≥50%; 9% vs. TTR <50%; 8%, P = 0.89).
Conclusion
Appropriate anticoagulation therapy may decrease the incidence of embolic events without increasing the incidence of bleeding events in patients with first AMI complicated by LV thrombus.</description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNqFkMtO3DAUQK2qqAy0-66Ql5WqgB-JEy9Ho7YgjcQGJHbRjXPdMcoL2wHmA_hvjDKwZWVZ99xj-RDyk7NzzrS8wNnvEHy8v8Ddc1HwL2TFCyEyrfLiK1kxrotMqerumJyEcM8YqxRX38ix0ExoIeWKvKyH6MwI_-cOohsHasa-cQO29MnFHYU0ndIEO4w07tDDtKduoFOCcYhhoTq0kT6mu3cmeXwifdLMgYKN6Kl1PkQKZo5I-_1owLcOuuSx4M3bq9_JkYUu4I_DeUpu__652Vxm2-t_V5v1NjOyLGMGAllVKlOClCVUxmrTouUMlJBGAqb_Cps3rdRFpUVT5KZh2EIJwjQaVC5Pya_FO_nxYcYQ694Fg10HA45zqFMvnvOSlSqhbEGNH0PwaOvJux78vuasfotff8Svl_hp5exgn5se24-F99oJ-L0A4zx9rnsFufSX6Q</recordid><startdate>20180114</startdate><enddate>20180114</enddate><creator>Maniwa, Naoki</creator><creator>Fujino, Masashi</creator><creator>Nakai, Michikazu</creator><creator>Nishimura, Kunihiro</creator><creator>Miyamoto, Yoshihiro</creator><creator>Kataoka, Yu</creator><creator>Asaumi, Yasuhide</creator><creator>Tahara, Yoshio</creator><creator>Nakanishi, Michio</creator><creator>Anzai, Toshihisa</creator><creator>Kusano, Kengo</creator><creator>Akasaka, Takashi</creator><creator>Goto, Yoichi</creator><creator>Noguchi, Teruo</creator><creator>Yasuda, Satoshi</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20180114</creationdate><title>Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction</title><author>Maniwa, Naoki ; Fujino, Masashi ; Nakai, Michikazu ; Nishimura, Kunihiro ; Miyamoto, Yoshihiro ; Kataoka, Yu ; Asaumi, Yasuhide ; Tahara, Yoshio ; Nakanishi, Michio ; Anzai, Toshihisa ; Kusano, Kengo ; Akasaka, Takashi ; Goto, Yoichi ; Noguchi, Teruo ; Yasuda, Satoshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-a2e0876c7a337a8cf9cdef10a623c3ae0192f4bd395892b54cb0eda7a2cb9a643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maniwa, Naoki</creatorcontrib><creatorcontrib>Fujino, Masashi</creatorcontrib><creatorcontrib>Nakai, Michikazu</creatorcontrib><creatorcontrib>Nishimura, Kunihiro</creatorcontrib><creatorcontrib>Miyamoto, Yoshihiro</creatorcontrib><creatorcontrib>Kataoka, Yu</creatorcontrib><creatorcontrib>Asaumi, Yasuhide</creatorcontrib><creatorcontrib>Tahara, Yoshio</creatorcontrib><creatorcontrib>Nakanishi, Michio</creatorcontrib><creatorcontrib>Anzai, Toshihisa</creatorcontrib><creatorcontrib>Kusano, Kengo</creatorcontrib><creatorcontrib>Akasaka, Takashi</creatorcontrib><creatorcontrib>Goto, Yoichi</creatorcontrib><creatorcontrib>Noguchi, Teruo</creatorcontrib><creatorcontrib>Yasuda, Satoshi</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maniwa, Naoki</au><au>Fujino, Masashi</au><au>Nakai, Michikazu</au><au>Nishimura, Kunihiro</au><au>Miyamoto, Yoshihiro</au><au>Kataoka, Yu</au><au>Asaumi, Yasuhide</au><au>Tahara, Yoshio</au><au>Nakanishi, Michio</au><au>Anzai, Toshihisa</au><au>Kusano, Kengo</au><au>Akasaka, Takashi</au><au>Goto, Yoichi</au><au>Noguchi, Teruo</au><au>Yasuda, Satoshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2018-01-14</date><risdate>2018</risdate><volume>39</volume><issue>3</issue><spage>201</spage><epage>208</epage><pages>201-208</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract
Aims
There are limited data about the optimal anti-thrombotic therapy for preventing embolism while minimizing bleeding events in patients with first acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT).
Methods and results
Among 2301 consecutive patients with AMI hospitalized between 2001 and 2014, we studied 1850 patients with first AMI who discharged alive to investigate clinical characteristics, incidence of systemic embolism (SE), and association between anticoagulation and embolic or bleeding events. Left ventricular thrombus was diagnosed by echocardiography, left ventriculography, or cardiac magnetic resonance imaging in 92 (5.0%) patients (62 ± 12 years). During a median follow-up period of 5.4 years (interquartile range 2.1–9.1 years), SE occurred in 15 of 92 patients with LVT (16.3%) and 51 of 1758 patients without LVT (2.9%), respectively. Kaplan–Meier analysis showed a significantly higher incidence of SE in the LVT group (log-rank test, P < 0.001). Multivariate analysis showed that LVT was an independent predictor of SE. Among the LVT patients treated with vitamin K antagonists (n = 84), we compared the patients with therapeutic range (TTR) ≥50% (n = 34) and those with TTR <50% (n = 50). Only one embolic event developed in the TTR ≥50% group and nine embolic events developed in the TTR <50% group (2.9% vs. 19%, P = 0.036). There was no difference in major bleeding events (TTR ≥50%; 9% vs. TTR <50%; 8%, P = 0.89).
Conclusion
Appropriate anticoagulation therapy may decrease the incidence of embolic events without increasing the incidence of bleeding events in patients with first AMI complicated by LV thrombus.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>29029233</pmid><doi>10.1093/eurheartj/ehx551</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| title | Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction |
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