Key result
Post-procedural anticoagulation with enoxaparin after primary percutaneous coronary intervention was independently associated with a significantly lower incidence of left ventricular thrombus (OR 0.139) at 30 days.
Why the study?
Although short-term anticoagulation reduced left ventricular thrombus formation during the thrombolytic era in patients with anterior AMI and LV dysfunction, the effect of prophylactic anticoagulation remains unclear in the current era.
Does post-procedural anticoagulation with enoxaparin reduce left ventricular thrombus formation at 30 days in patients with anterior AMI and LVEF ≤40% undergoing primary PCI?
Cohort (n=426)
No
Does post-procedural anticoagulation with enoxaparin reduce left ventricular thrombus formation at 30 days in patients with anterior AMI and LVEF ≤40% undergoing primary PCI?
Odds Ratio: 0.139 (95% CI 0.032–0.606)
Absolute Event Rate: 2.4% vs 8.1%
p-value: p=0.009
Short-term post-procedural anticoagulation with enoxaparin after primary PCI significantly reduced the risk of left ventricular thrombus formation at 30 days in patients with anterior AMI and severe LV dysfunction, without increasing major bleeding.
May reduce LV thrombus after anterior AMI with LV dysfunction; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Patients with anterior acute myocardial infarction (AMI) and left ventricular (LV) dysfunction have an increased risk of LV thrombus (LVT). In the thrombolytic era, short-term anticoagulation using low-molecular-weight heparin during hospitalization proved to significantly reduce LVT formation, but, the effect of this prophylactic approach remains unclear in the current era. Therefore, we conducted a study to evaluate the effects of post-procedural anticoagulation (PPAC) using enoxaparin in addition to dual antiplatelet therapy (DAPT) after primary percutaneous coronary intervention (PCI) in such patients. METHODS AND RESULTS: A total of 426 anterior AMI patients with LV ejection fraction ≤40% were retrospectively enrolled and classified into 2 groups based on whether they received PPAC (enoxaparin SC for at least 7 days). All patients received primary PCI and DAPT. The primary endpoint was definite LVT at 30 days diagnosed by echocardiography. The secondary endpoints were 30-day mortality, embolic events, and major bleeding events. PPAC was independently associated with a lower incidence of LVT (odds ratio 0.139, 95% confidence interval 0.032-0.606, P=0.009). The 30-day mortality, embolic events, and major bleeding events were not statistically different between groups. CONCLUSIONS: Short-term PPAC using enoxaparin after primary PCI may be an effective and safe way to prevent LVT in patients with anterior AMI and LV dysfunction.
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Chen et al. (2020) conducted a cohort in Anterior acute myocardial infarction with severe left ventricular dysfunction (n=426). Post-procedural anticoagulation (enoxaparin) vs. No post-procedural anticoagulation was evaluated on Definite left ventricular thrombus (LVT) at 30 days diagnosed by echocardiography (OR 0.139, 95% CI 0.032-0.606, p=0.009). Post-procedural anticoagulation with enoxaparin after primary percutaneous coronary intervention was independently associated with a significantly lower incidence of left ventricular thrombus (OR 0.139) at 30 days.
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