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https://doi.org/10.1016/j.ijcard.2020.12.087
Title: | Outcomes of left ventricular thrombosis in post-acute myocardial infarction patients stratified by antithrombotic strategies: A meta-analysis with meta-regression | Authors: | Low, Christopher Junyan Leow, Aloysius Sheng-Ting Syn, Nicholas Li-Xun Tan, Benjamin Yong-Qiang Yeo, Leonard Leong-Litt Tay, Edgar Lik-Wui Yeo, Tiong-Cheng Chan, Mark Yan-Yee Loh, Joshua Ping-Yun Sia, Ching-Hui |
Keywords: | Acute myocardial infarction Anticoagulation Antithrombotic therapy Left ventricular thrombus Meta-analysis Outcomes |
Issue Date: | 15-Apr-2021 | Publisher: | ELSEVIER IRELAND LTD | Citation: | Low, Christopher Junyan, Leow, Aloysius Sheng-Ting, Syn, Nicholas Li-Xun, Tan, Benjamin Yong-Qiang, Yeo, Leonard Leong-Litt, Tay, Edgar Lik-Wui, Yeo, Tiong-Cheng, Chan, Mark Yan-Yee, Loh, Joshua Ping-Yun, Sia, Ching-Hui (2021-04-15). Outcomes of left ventricular thrombosis in post-acute myocardial infarction patients stratified by antithrombotic strategies: A meta-analysis with meta-regression. INTERNATIONAL JOURNAL OF CARDIOLOGY 329 : 36-45. ScholarBank@NUS Repository. https://doi.org/10.1016/j.ijcard.2020.12.087 | Abstract: | Background: Left ventricular thrombus (LVT) formation is a significant complication of acute myocardial infarction (AMI) due to its embolic potential. However, managing LVT requires balancing therapeutic benefits against bleeding risks. Our study provides a risk-benefit analysis of various antithrombotic regimens on long-term outcomes in treating post-AMI LVT patients. Methods: We conducted a comprehensive literature search in Medline, Embase and SCOPUS up to 1 April 2020. All studies reporting outcomes of post-AMI LVT patients were included. Results: 17 studies were included in total. Anticoagulation (47–100%) and triple therapy use (38–100%) varied largely across studies. On meta-analysis, administration of anticoagulation (OR 0.14, 95% CI 0.05–0.36, p < 0.001) and triple therapy (OR 0.22, 95% CI 0.07–0.66, p < 0.001) resulted in lower odds of mortality. Neither anticoagulation (p = 0.24) nor triple therapy (p = 0.73) was associated with bleeding. Triple therapy was associated with LVT resolution on meta-analysis (OR 2.53, 95% CI 1.53–4.19, p < 0.001) and regression analysis (OR 1.28, 95% CI 1.03–1.58, p = 0.03). Anticoagulation and triple therapy were independent predictors of systemic embolism ([OR 0.67, 95% CI 0.49–0.93, p = 0.02] and [OR 0.82, 95% CI 0.73–0.93, p = 0.001]) and stroke ([OR 0.62, 95% CI 0.41–0.94, p = 0.03] and [OR 0.73, 95% CI 0.55–0.96, p = 0.03]). Conclusions: While there is clear therapeutic benefit in anticoagulation for post-AMI LVT, the extent of bleeding risk is uncertain. Future trials are necessary to determine the optimal antithrombotic strategy for post-AMI LVT management. | Source Title: | INTERNATIONAL JOURNAL OF CARDIOLOGY | URI: | https://scholarbank.nus.edu.sg/handle/10635/205767 | ISSN: | 01675273 18741754 |
DOI: | 10.1016/j.ijcard.2020.12.087 |
Appears in Collections: | Elements Staff Publications |
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