Key result
Triple antithrombotic therapy fails to reduce LV thrombus vs DAPT while increasing major bleeding.
Why the study?
The efficacy and safety of triple antithrombotic therapy versus dual antiplatelet therapy for preventing left ventricular thrombus after anterior myocardial infarction required updated evaluation.
Does triple antithrombotic therapy reduce left ventricular thrombus formation in patients with anterior myocardial infarction compared with dual antiplatelet therapy alone?
Meta-Analysis (n=2,273)
Yes
Does triple antithrombotic therapy reduce left ventricular thrombus formation in patients with anterior myocardial infarction compared with dual antiplatelet therapy alone?
Odds Ratio: 0.56 (95% CI 0.21–1.49)
p-value: p=0.25
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our updated meta-analysis is now published in Clinical and Applied Thrombosis/Hemostasis. Compared with DAPT alone, prophylactic triple antithrombotic therapy after anterior STEMI: Did not significantly reduce LV thrombus; No reduction in mortality or thromboembolic events; Increased major bleeding. Routine prophylactic triple therapy may not be justified—careful patient selection remains essential.”
In patients with anterior myocardial infarction, adding systemic anticoagulation to dual antiplatelet therapy does not significantly reduce left ventricular thrombus formation but significantly increases the risk of major bleeding.
Purpose To evaluate the efficacy and safety of triple antithrombotic therapy (TT) versus dual antiplatelet therapy (DAPT) for prevention of left ventricular thrombus (LVT) following anterior myocardial infarction. Methods We conducted a systematic review and meta-analysis of randomized and observational studies comparing TT (DAPT plus anticoagulation) versus DAPT alone. The primary outcome was LVT formation. Secondary outcomes included all-cause mortality, stroke, systemic embolism, composite thromboembolism, bleeding, and net adverse clinical events (NACE). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. The protocol was registered in PROSPERO (CRD420261343867). Results Seven studies (2 randomized, 5 observational), including 2,273 patients (949 TT, 1,324 DAPT), were analyzed. TT was not associated with a reduction in LVT (OR 0.56, 95% CI 0.21–1.49; p=0.25; I 2 =59%). There was no significant difference in all-cause mortality (OR 0.75, 95% CI 0.27–2.06; p=0.58), ischemic cerebrovascular accidents (OR 1.17, 95% CI 0.20–6.79), systemic embolism (OR 0.69, 95% CI 0.27–1.75), or composite thromboembolism (OR 0.96, 95% CI 0.42–2.19). TT was associated with increased major bleeding (OR 2.82, 95% CI 1.40–5.68; p=0.004) and any bleeding (OR 2.58, 95% CI 1.73–3.85; p<0.001). There was no significant difference in NACE (OR 1.15, 95% CI 0.58–2.29). Conclusion In anterior myocardial infarction, available evidence did not demonstrate a statistically significant reduction in LVT or thromboembolic events with TT compared with DAPT, while bleeding risk was increased. Given moderate heterogeneity, limited randomized evidence, and potential imaging-related under-detection of LVT, these findings do not support routine prophylactic TT and favor individualized risk–benefit assessment.
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Abomohsen et al. (2026) conducted a meta-analysis in Anterior myocardial infarction (n=2,273). Triple antithrombotic therapy (DAPT plus anticoagulation) vs. Dual antiplatelet therapy (DAPT) alone was evaluated on Left ventricular thrombus (LVT) formation (OR 0.56, 95% CI 0.21-1.49, p=0.25). Triple antithrombotic therapy did not significantly reduce left ventricular thrombus formation compared to dual antiplatelet therapy alone (OR 0.56, 95% CI 0.21-1.49, p=0.25), but significantly increased the risk of major bleeding.
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